Surgical management of temple-related problems following lateral wall rim-sparing orbital decompression for thyroid-related orbitopathy

• Published in: British journal of ophthalmology Vol. 100; no. 8; pp. 1144 - 1150
• Main Authors: Siah, We Fong, Patel, Bhupendra CK, Malhotra, Raman
• Format: Journal Article
• Language: English
• Published: England 01.08.2016
• Subjects: Adult; Aged; Decompression, Surgical - adverse effects; Female; Follow-Up Studies; Graves Ophthalmopathy - diagnosis; Graves Ophthalmopathy - surgery; Humans; Male; Middle Aged; Ophthalmologic Surgical Procedures - methods; Orbit - diagnostic imaging; Orbit - surgery; Postoperative Complications - diagnosis; Postoperative Complications - etiology; Postoperative Complications - surgery; Prognosis; Reoperation; Retrospective Studies; Tomography, X-Ray Computed; Visual Acuity; Young Adult; Orbit; Cosmesis; Treatment Surgery
• ISSN: 0007-1161; 1468-2079
• DOI: 10.1136/bjophthalmol-2015-307600

AimTo report a case series of patients with persistent temple-related problems following lateral wall rim-sparing (LWRS) orbital decompression for thyroid-related orbitopathy and to discuss their management.MethodsRetrospective review of medical records of patients referred to two oculoplastic centres (Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, UK and Moran Eye Center, University of Utah, Salt Lake City, USA) for intervention to improve/alleviate temple-related problems. All patients were seeking treatment for their persistent, temple-related problems of minimum 3 years’ duration post decompression. The main outcome measure was the resolution or improvement of temple-related problems.ResultsEleven orbits of six patients (five females) with a median age of 57 years (range 23–65) were included in this study. Temple-related problems consisted of cosmetically bothersome temple hollowness (n=11; 100%), masticatory oscillopsia (n=8; 73%), temple tenderness (n=4; 36%), ‘clicking’ sensation (n=4; 36%) and gaze-evoked ocular pain (n=4; 36%). Nine orbits were also complicated by proptosis and exposure keratopathy. Preoperative imaging studies showed the absence of lateral wall in all 11 orbits and evidence of prolapsed lacrimal gland into the wall defect in four orbits. Intervention included the repair of the lateral wall defect with a sheet implant, orbital decompression involving fat, the medial wall or orbital floor and autologous fat transfer or synthetic filler for temple hollowness. Postoperatively, there was full resolution of masticatory oscillation, temple tenderness, ‘clicking’ sensation and gaze-evoked ocular pain, and an improvement in temple hollowness. Pre-existing diplopia in one patient resolved after surgery while two patients developed new-onset diplopia necessitating strabismus surgery.ConclusionsThis is the first paper to show that persistent, troublesome temple-related problems following LWRS orbital decompression can be surgically corrected. Patients should be counselled about the potential risk of these complications when considering LWRS orbital decompression.