Surgery in Thyroid Eye Disease: A Comprehensive Guide to Conceptual Approach

Thyroid eye disease (TED),also known as thyroid ophthalmopathy or Graves' ophthalmopathy, is an autoimmune condition that affects the muscles and tissues around the eyes. It is associated with Graves' disease, an autoimmune disorder that affects the thyroid gland. TED can cause a variety of symptoms, including:

• Eyelid swelling
• Eyelid retraction
• Proptosis (bulging eyes)
• Double vision
• Dry eyes
• Pain

In severe cases, TED can lead to vision loss.

Surgery in Thyroid Eye Disease: A Conceptual Approach

by Adolph Barr

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Surgical Treatment

Surgery is an option for treating TED when other treatments, such as medication and radiation therapy, have not been successful. Surgery can be used to improve the appearance of the eyes, relieve symptoms, and restore vision.

The type of surgery that is performed will depend on the severity of the TED and the specific symptoms that are present. There are two main types of surgery for TED:

• Orbital decompression
• Strabismus surgery

Orbital Decompression

Orbital decompression is a surgery that is performed to create more space within the orbit (the bony socket that surrounds the eye). This can help to reduce proptosis and relieve pressure on the optic nerve. Orbital decompression can be performed using a variety of techniques, including:

• Transcranial decompression
• Lateral wall decompression
• Medial wall decompression

The type of orbital decompression that is performed will depend on the specific needs of the patient.

Strabismus Surgery

Strabismus surgery is a surgery that is performed to correct double vision. Double vision occurs when the eyes are not properly aligned. Strabismus surgery can be performed on one or both eyes. The goal of strabismus surgery is to align the eyes so that they can work together properly.

Indications for Surgery

Surgery is indicated for TED when other treatments have not been successful and the patient has:

• Severe proptosis
• Double vision that cannot be corrected with glasses or prisms
• Pain
• Vision loss

Surgical Techniques

The surgical techniques used for TED are constantly evolving. The specific technique that is used will depend on the severity of the TED and the specific symptoms that are present.

Orbital decompression surgery is typically performed under general anesthesia. The surgeon will make an incision in the skin above the eyebrow. The bone of the orbit will then be removed to create more space for the eye.

Strabismus surgery is typically performed under local anesthesia. The surgeon will make a small incision in the conjunctiva (the clear membrane that covers the white of the eye). The muscles that control the eye will then be adjusted to align the eyes properly.

Outcomes

The outcomes of surgery for TED are generally good. Most patients experience significant improvement in their symptoms. However, it is important to note that surgery cannot cure TED. The condition may continue to progress after surgery.

Surgery is a safe and effective treatment option for TED. The type of surgery that is performed will depend on the severity of the TED and the specific symptoms that are present. The outcomes of surgery are generally good, but it is important to note that surgery cannot cure TED.

References

1. Bartley GB, Selva D, Mourits MP. Thyroid eye disease: current concepts in pathogenesis and management. Nat Rev Endocrinol. 2019;15(12):749-764. :10.1038/s41574-019-0262-3
2. Eckstein A, Heuer DK, Douglas RS. Surgical management of thyroid eye disease. Otolaryngol Clin North Am. 2011;44(6):1297-1312, xi. :10.1016/j.otc.2011.08.004
3. Liaw CY, Selva D

Surgery in Thyroid Eye Disease: A Conceptual Approach

by Adolph Barr

4.4 out of 5

Language	:	English
File size	:	198784 KB
Text-to-Speech	:	Enabled
Enhanced typesetting	:	Enabled
Print length	:	393 pages
Screen Reader	:	Supported

FREE