Thyroid Eye Disease: A Treatment, Surgery for Orbital Decompression

From ThyroWorld Volume 1, No 2

The bony orbit is like a pyramid with the square base facing forwards, much like one of the segments of an egg box. When the quantity of fat and muscle surrounding the eyeball increases as in thyroid eye disease, the eye is inevitably pushed forwards. Ophthalmologists are very careful to pick up the more serious consequences of severe disease but nearly all patients find the cosmetic appearances distressing. If the displacement of the eye is severe and other medical treatments have not proved successful, a surgical decompression may be offered which may be done by the eye surgeon with or without the help of an ENT colleague.

Decompression simply means creating more space for the contents of the orbit, allowing the eyeball to sink back into the socket. To achieve this any one or more of the four walls of the pyramid can be removed but the amount of space and the size of the operation varies with the different approaches. One of the biggest operations involves removing the bone between the roofs of the orbits and the inside of the skull to give access to the very back of the eye from above. The most popular procedure involves removing the bony wall between the eye and the nose and between the floor of the orbit and the maxillary sinus which occupies the cheek bone.

There are various ways of reaching these areas; by a small cut on the face which usually heals well, or through a cut in the gum, or most recently through the nose alone using a fibre-optic system which avoids external cuts. Once the bone has been removed, the fibrous lining of the orbit is incised allowing the fat to prolapse into the adjacent sinus cavities. Immediately following the operation, patients often experience some double vision which usually improves with time but may sometimes require a second operation, this time on the muscles of the eyes to help re-align them. Watering of the eye and some numbness and bruising of the cheek may also occur for a short time after the surgery.

It is difficult to predict how much the eye will go back into the socket but most patients notice an obvious improvement in their appearance within a few weeks of the operation. ·

Peter Fells, FRCS, FRCOphth
Valerie J Lund, MS, FRCS, FRCSEd

Copyright © 1998 TED Thyroid Eye Disease Association