Orbital decompression in exophthalmos due to thyroid disease. Report of 69 cases

Dysthyroid exophthalmos is due to mismatching of the orbit and its contents, essentially due to muscle enlargement, and, to a lesser degree, fat volumetric changes. Surgical treatment is designed to expand the orbital volume by bone removal or to reduce orbital contents by fat removal, or a combination of the two techniques. Our series consisted of 69 patients who underwent orbital decompression for proptosis, with osteotomy (12 cases) or associated with fat removal (57 cases). We obtained good results for all cases, and did not encounter any complications. Several factors now appear to play a role in the choice of surgical technique, particularly the preoperative radiologic (CT) examination which determines the muscular and fat involvement, wall orbital changes and appearance of the sinuses. Orbital fat removal seems to be useful in proptosis reduction in those cases in which fat is more involved and easy to remove. Anthral ethmoidal decompression is the best technique in the case of dysthyroid optic neuropathy.