Correction of exophthalmos and eyelid deformities in patients with severe thyroid ophthalmopathy.

Conservative therapy in cases of severe thyroid ophthalmopathy has not given satisfactory results. Because of this, surgical treatment, that is, orbital decompression, is now being used with increasing frequency. Since the end of 1986 until the end of 2006, 103 patients with severe thyroid ophthalmopathy have been treated by personal 3-wall orbital decompression combined with removal of the periorbital, intraorbital, and retrobulbar fat, as well as with correction of eyelid retraction and deformities. After operation, all patients showed a significant reduction of exophthalmos (5-11 mm; 7.2 mm on average), reduction of intraocular pressure, marked improvement in ocular muscle function, and considerable reduction or disappearance of subjective symptoms. There was an improvement in vision in 68% patients who had impaired vision before the operation. There were no cases of subsequent impairment of ocular motility. Mild relapse of exophthalmos was recorded in 3 cases only, and only 1 patient required unilateral reoperation. Strabismus surgery had to be performed in 6 patients due to unsatisfactory correction of double vision. It can be concluded that this method of orbital decompression gives constantly very good functional and aesthetic long-term results and allows rapid recovery.