The transconjunctival approach with lateral canthal extension for three-wall orbital decompression in thyroid orbitopathy

Background: G raves' disease associated orbitopathy (thyroid orbitopathy) gives rise to a characteristic facial appearance and aesthetic concerns due to exophthalmus and eyelid abnormalities, most notably upper eyelid retraction. Involvement of ocular muscles or compression of the optic nerve near the orbital apex can lead to diplopia and decreased visual acuity. Methods: Seven patients with thyroid orbitopathy were operated upon and their charts retrospectively reviewed. Orbital decompression was performed through a bilateral transconjunctival approach with lateral canthal extension for aesthetic correction of proptosis, functional problems and decrease of visual acuity. Results: Mean pre-operative Hertel values of 23 mm for the left eye and 23 mm for the right eye decreased significantly with 5.4 mm and 4.7 mm, respectively. Functional problems improved in 75% of the patients whereas when visual acuity was the indication for surgery only minor changes were observed. The patient operated solely for aesthetic reasons was extremely satisfied with her outcome. Additional surgery (strabismus and eyelid correction) was necessary in 70% of the patients. Complication rate was low with permanent hypoaesthesia of one infra-orbital nerve (one out of 14). No infective complications were noted and scarring was hidden. Conclusion: Based on the findings of this study and review of the literature it is concluded that the transconjunctival approach with lateral canthal extension is a safe and very effective route when surgical decompression of the orbit is indicated and therefore should be considered the approach of first choice. (C) 2008 European Association for Cranio-Maxillofacial Surgery