Optic neuropathy in thyroid eye disease: results of the balanced decompression technique.

OBJECTIVE: To determine the efficacy of combined endoscopic medial and external lateral orbital decompression for the treatment of compressive optic neuropathy (CON) in thyroid eye disease (TED).

DESIGN: A retrospective review of all patients undergoing combined surgical orbital decompression for CON between 2000 and 2010 was conducted.

PARTICIPANTS: Fifty-nine eyes of 34 patients undergoing combined surgical orbital decompression for CON.

METHODS: Clinical outcome measures included visual acuity, Hardy-Rand-Rittler (HRR) colour plate testing, relative afferent pupillary defect, intraocular pressure measurement, and Hertel exophthalmometry. A CON score was calculated preoperatively and postoperatively based on the visual acuity and the missed HRR plates. A higher CON score correlates with more severe visual dysfunction.

RESULTS: All patients had improvement of their optic neuropathy after surgical decompression. CON score was calculated for 54 eyes and decreased significantly from a mean of 13.2 ± 10.35 preoperatively to a mean of 8.51 ± 10.24 postoperatively (p < 0.0001). Optic neuropathy was completely resolved in 93.22% (55/59 eyes). Eighteen of 34 patients (52.94%) experienced development of new-onset postoperative strabismus that required subsequent surgical intervention.

CONCLUSIONS: Endoscopic medial combined with external lateral orbital decompression is an effective technique for the treatment of TED-associated CON.