Surgical orbital decompression in Graves' orbitopathy
DOI:
https://doi.org/10.20883/Keywords:
exophthalmos, Graves' disease, orbital decompression, canthotomy, thyroid eye diseaseAbstract
Graves' orbitopathy (GO) is a chronic autoimmune condition causing inflammation in the orbit, leading to exophthalmos (bulging eyes) and a "startled" look. Untreated, it can cause corneal ulcers or vision loss, making early diagnosis vital. This report details a 37-year-old female admitted for urgent surgery due to progressive GO since December 2023. Presenting with asymmetric exophthalmos, superior orbital muscle enlargement, and excess retrobulbar fat, she was qualified for right orbital decompression surgery. The procedure involved lateral and medial orbital wall access, resection of a bone segment, and removal of 3.5 ml of periorbital fat. This increased orbital volume and successfully reduced the exophthalmos. The patient was also referred for strabismus and eyelid retraction correction, with potential blepharoplasty. Orbital decompression is sometimes an emergency procedure in advanced GO. Treatment is individualised and interdisciplinary, combining drugs, radiotherapy, and surgery based on disease severity.
Downloads
References
Sawicka-Gutaj N, Gruszczyński D, Zawalna N, Nijakowski K, Fichna M, Ruchała M. Misfortunes do not come in pairs in patients with active moderate-to-severe Graves' orbitopathy. Pol Arch Intern Med. 2024;134:16773. https://doi.org/10.20452/pamw.16773
Bahn RS. Graves' ophthalmopathy. N Engl J Med. 2010;362(8):726–38. https://doi.org/10.1056/NEJMra0905750
Wiersinga WM, Kahaly GJ. Graves' Orbitopathy: A Multidisciplinary Approach—Questions and Answers. Cham: Springer; 2017.
Smith TJ, Hegedüs L. Graves' disease. N Engl J Med. 2016;375(16):1552–65. https://doi.org/10.1056/NEJMra1510030
Douglas RS, Kahaly GJ, Patel A, Sile S, Thompson EH, Perdok R, et al. Teprotumumab for the treatment of active thyroid eye disease. N Engl J Med. 2020;382(4):341–52. https://doi.org/10.1056/NEJMoa1910434
Bartalena L, Baldeschi L, Boboridis K, Eckstein A, Kahaly GJ, Marcocci C, et al. Consensus statement of the European Group on Graves' Orbitopathy (EUGOGO). Eur J Endocrinol. 2021;185(4):G43–67. https://doi.org/10.1530/EJE-21-0615
Sawicka-Gutaj N, Gruszczyński D, Zawalna N, Nijakowski K, Skiba A, Pochylski M, et al. Safety of non-standard regimen of systemic steroid therapy in patients with Graves' orbitopathy: a single-centre experience. Pharmacol Rep. 2024;76:185–94. https://doi.org/10.1007/s43440-023-00567-0
Mourits MP, Koornneef L, Wiersinga WM, Prummel MF, Berghout A, van der Gaag R. Surgical decompression for thyroid-associated orbitopathy. Orbit. 2001;20(4):263–72. https://doi.org/10.1076/orbi.20.4.263.2481
Leone CR, Henderson JW. Orbital decompression surgery for Graves' orbitopathy. In: Mourits MP, Prummel MF, eds. Surgical Management of Graves' Orbitopathy. Cham: Springer; 2017. p. 53–68.
Gioacchini FM, Kaleci S, Cassandro E, Scarpa A, Tulli M, Cassandro C, et al. Orbital wall decompression in the management of Graves' orbitopathy: a systematic review with meta-analysis. Eur Arch Otorhinolaryngol. 2021;278(11):4135–45. https://doi.org/10.1007/s00405-021-06698-5
Ye Y, Liu Y, Zhang X. The outcomes of endoscopic orbital decompression combined with fat decompression for thyroid-associated ophthalmopathy. BMC Ophthalmol. 2023;23(1):1–8. https://doi.org/10.1186/s12886-023-02957-7
Ruiz-de-Leon G, Ochandiano S, Alvarez-Mokthari S, Benito-Anguita M, Nieva-Pascual I, Cifuentes-Canorea P, Sanjuan-de-Moreta G, Salmeron J-I, Navarro-Cuellar I, Navarro-Cuellar C, Tousidonis M. Volumetric analysis of navigation-guided orbital decompression in Graves' orbitopathy: a case report. Life. 2025;15(8):1277. https://doi.org/10.3390/life15081277
Rootman DB, Chu EA, Goldberg RA. Orbital decompression for thyroid eye disease. In: Yanoff M, Duker JS, editors. Ophthalmology. 5th ed. Philadelphia: Elsevier; 2022. p. 1595–602.
Dagi LR, Pier DB, Santiago AP. Strabismus after orbital decompression: Mechanisms and management. Curr Opin Ophthalmol. 2017;28(5):460–5. https://doi.org/10.1097/ICU.0000000000000405
Dolman PJ. Evaluating and treating restrictive strabismus in thyroid eye disease. Middle East Afr J Ophthalmol. 2015;22(3):307–15. https://doi.org/10.4103/0974-9233.159759
Published
Issue
Section
License
Copyright (c) 2026 The copyright to the submitted manuscript is held by the Author, who grants the Journal of Face Aesthetics (JoFA) a nonexclusive licence to use, reproduce, and distribute the work, including for commercial purposes.
This work is licensed under a Creative Commons Attribution 4.0 International License.
