Preoperative Assessment and Orbital Decompression Surgery in Patients with Graves’ Ophthalmopathy
Many of the signs and symptoms of Graves’ ophthalmopathy result from a discrepancy between the increased volume of the swollen orbital contents and the fixed volume of the bony orbit. While the natural history of the disease includes spontaneous improvement for most and for those patients who require some form of treatment, therapeutic efforts to address this imbalance exist. One can attempt to “shrink” the swollen tissues with corticosteroids, radiation therapy, or immunosuppression. Alternatively the volume of the bony orbit can be expanded by surgically decompressing various walls of the orbit. The amount of proptosis reduction varies according to the number of orbital walls decompressed. There are many different techniques of surgical orbital decompression and the choice of procedure is often surgeon/institution specific. This chapter reviews some of the differential diagnostic considerations encountered in the preoperative evaluation of patients with Graves’ ophthalmopathy along with a discussion of the various types of orbital decompression.
KeywordsGraves’ orbitopathy Graves’ ophthalmopathy Thyroid eye disease Orbit Orbital decompression Thyroid