Graves Disease Orbital Decompression

Thyroid eye disease (TED), or thyroid-associated ophthalmopathy (TAO), thyroid orbitopathy, Graves’ orbitopathy, or Graves’ ophthalmopathy, causes orbital congestion and proptosis due to extraocular muscle and orbital fat enlargement with fibrosis. These anatomical alterations can result in compressive optic neuropathy, exposure keratopathy, and ocular motility disorders. Treatment of proptosis from thyroid eye disease consists of orbital decompression, taking advantage of the adjacent sinus spaces to expand orbital volume. Based on patient presentation, the amount of decompression required is determined on a case-by-case basis. For example, in cases of moderate to severe proptosis, medial wall, lateral wall, and floor decompression can be done, taking advantage of the adjacent ethmoid sinuses, maxillary sinus, and orbital trigone, respectively.