Effect of Orbital Decompression on Diplopia in Thyroid-Related Orbitopathy

Abstract

Review of the charts of patients who underwent orbital decompression surgery for thyroid-related orbitopathy revealed a preoperative prevalence of diplopia of 26% and a postoperative prevalence of 40.7%. Amongst the patients with preoperative diplopia (n = 32), 28.1% (n = 9) had complete resolution of their diplopia after decompression, while 65.6% (n = 21) remained stable and 6.3% (n = 2) worsened. The incidence of new-onset diplopia was 29.7% in this case series of orbital decompression using a transcaruncular and swinging eyelid approach for medial wall and strut-sparing floor decompression. Rates of new-onset diplopia were significantly higher when periorbita was opened (40.0%, n = 82) compared with when it was left intact (11.8%, n = 37) CONCLUSIONS:: It has previously been reported in the literature that orbital decompression for thyroid-related orbitopathy can cause diplopia in a significant number of cases. This provides the rational for performing orbital decompression prior to strabismus surgery in the management of thyroid-related orbitopathy. In this case series, the authors noted resolution of diplopia in a significant proportion (28.1%) of patients with preexisting diplopia. This is rarely commented on in other articles but is important in the preoperative discussion. An incidence of new-onset diplopia of 29.7% was identified. Opening the periorbita was associated with an increased incidence of new-onset diplopia.

A Novel Three-Dimensional Vector Analysis of Axial Globe Position in Thyroid Eye Disease

“…Of course, the influence came from extrusion of the expanded orbital tissue, and the shift during ocular ductions could not be excluded completely [25]. Additionally, due to changes in orbital bone, fat, and extraocular muscles, eyeball motion can be complicated during TED surgery, possibly leading to changes in strabismus or exophthalmos [26, 27]. The vector method might help us to better study the effects of surgery better in TED patients, including eyeball shift and rotation.…”

Vertical Diplopia and Ptosis from Removal of the Orbital Roof in Pterional Craniotomy

“…When possible the orbital periosteum should be left intact, to create a barrier between the dura mater and the orbital contents. In a recent study of orbital decompression in thyroid eye disease, Mainville and colleagues reported only an 11.8% rate of diplopia when the periorbita was left intact, compared with a 40.0% rate when it was violated 38 The orbital fat overlaying the superior rectus/levator complex should be disturbed as little as possible. Animal models have confirmed that changes in fat localization and subsequent tethering of tissues can lead to extra-ocular movement dysfunction.…”

Thyroid eye disease: a review

“…In a series of 78 patients who had transantral or endonasal bone decompression, proptosis was reduced by 4.4 to 4.7 mm, visual acuity improved in 44 to 55 per cent of subjects and diplopia persisted in 50 per cent of subjects but was improved in 54 per cent of those subjects . In a different series, 28 per cent of patients experienced resolution of diplopia following orbital bone decompression . Orbital fat decompression can be combined with bone decompression or performed alone for reduction of proptosis and improvement in diplopia .…”

“…54 In a different series, 28 per cent of patients experienced resolution of diplopia following orbital bone decompression. 55 Orbital fat decompression can be combined with bone decompression or performed alone for reduction of proptosis and improvement in diplopia. 56,57 Exposure keratopathy can be treated with temporary tarsorrhaphy while awaiting orbital decompression.…”