The surgical management of thyroid ophthalmopathy

ABSTRACT

It is mandatory to determine whether the patient with thyroid eye disease is in the acute, sub-acute (inflammatory) phrase or the chronic (burnt out) phrase. Patients in the inflammatory phrase are best treated with either anti-flammatory drugs (steroids, immunosuppressives), or radiotherapy. Patients in the burnt-out (fibrotic) phrase are best treated with surgery if required. There are three types of surgery in thyroid eye disease 1. Eye lid surgery (lid lengthening, blepharoplasty, tarsorrhaphy) which may be performed for cosmetic purposes, or, more frequently, to protect the cornea. 2. Strabismus surgery, mainly recessions of the inferior rectus and/or medial rectus muscles, if the patient is unhappy with prisms. 3. Orbital decompression either via the trans-ethmoidal route for unremitting optic neuropathy, or the lateral route for exophthalmos without optic neuropathy.(AU)