Orbital Decompression for Thyroid-Related Orbitopathy During the Quiescent Phase

Purpose: To describe historical and modern surgical approaches to orbital decompression in patients with thyroid-related orbitopathy in the quiescent phase. Methods: A literature review of published techniques using the National Institutes of Health PubMed database. Results: Historically, orbital decompression has been accomplished via transantral, transcranial, transnasal, and orbital approaches. Current techniques use predominately periocular incisions to achieve effective decompression and proptosis reduction. Based on exophthalmometry and desired proptosis reduction, the authors propose a graded surgical approach to decompression for thyroid orbitopathy beginning with fat reduction, followed by deep lateral orbit via a superior eyelid crease incision, then medial wall by retro-caruncular approach, then posterior medial orbital floor either via transconjunctival or swinging eyelid approach, and finally with lateral orbital rim removal by superior eyelid crease incision as needed. These approaches can result in a range of proptosis reduction of up to 10 mm. Conclusions: A structured approach to orbital decompression results in predictable and effective outcomes in proptosis reduction. Accepted for publication February 8, 2018. Supported by the Bell Charitable Foundation, Rancho Santa Fe, CA; Research to Prevent Blindness, New York, NY. None of the authors have any proprietary or commercial interest in any materials discussed in this article. Address correspondence and reprint requests to Don O. Kikkawa, M.D., Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Department of Ophthalmology, Shiley Eye Institute, La Jolla, CA. E-mail: dkikkawa@ucsd.edu © 2018 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.