Orbital decompression in the system of treatment for complicated thyroid eye disease: case report and literature review

Abstract

Orbital decompression is a surgical procedure aimed at increasing the orbital volume and/or decreasing the volume of the orbital fat. The indications for orbital decompression are determined in the course of thorough eye examination. An important objective of examination of a patient with thyroid eye disease (TED) is determination of inflammation activity and severity. Orbital decompression is a surgical procedure that can be performed in both the active and nonactive stages of the disease. However, the indications for the surgery in these cases are different. Optic neuropathy and severe corneal disease are threatening complications that may lead to permanent visual loss and generally occur in the presence of active orbital inflammation. If treatment with high-dose corticosteroids has proven ineffective, an urgent surgical procedure consisting of orbital decompression and, in case of involvement of the cornea, eyelid and corneal surgery has to be performed. Owing to significant progress in technology, improvement of methods and accumulated experience over the past decade, the indications for bone orbital decompression have extended compared to the time when this procedure was used only in patients with extremely severe TED. The most common complication of the orbital decompression is the development or deterioration of previously existing binocular diplopia and strabismus. In addition, other parameters may change as well, including the position of the globe, the eyelids, the angle of deviation of the eye, and intraocular pressure. Thus, bone orbital decompression is a major step of a comprehensive, often multistage, system of rehabilitation of patients with severe refractory TED.

An integrated approach to the treatment of pretibial myxedema based on pulse therapy with prednisolone and electrical neuromyostimulation (FREMS-therapy) in a patient with Graves’ disease and thyroid eye disease

“…После операций достигнута четкая положительная динамика по зрительным функциям: повышение остроты зрения с 0,7 до 1,0; данным компьютерной периметрии и параметрам цветового зрения. В наиболее тяжелых случаях оптической нейропатии при больших мышцах эффективен максимальный объем декомпрессии — 2,5 стенок [ 12 ]. На МСКТ после операций на орбитах отмечается адекватное увеличение объема костной орбиты в задней части, необходимое при апикальном синдроме (рис.…”

Identification of optimal surgical plan for treatment of extraocular muscle damage in thyroid eye disease patients based on computational biomechanics

“…Surgical treatments are a multistage approach, and 20%–30% of TED patients are offered this option after the disease stabilizes. Orbital decompression is the first stage in sequential surgical treatment and is performed in inactive TED patients with severe proptosis, exposure keratopathy, facial disfigurement, persistent prolonged congestion, and high IOP ( Ismailova et al, 2018 ). When vision is threatened by compressive optic neuropathy, emergent orbital decompression may be needed, even in the active TED phase ( Wang et al, 2019 ).…”

A data-driven approach for the discovery of biomarkers associated with thyroid eye disease

“…However, more serious cases may be treated with corticosteroids which reduce swelling of tissues around the eyes. Orbital therapy and orbital decomposition surgery are also used to treat TED [ 23 , 24 ].…”