A review of combined orbital decompression and lower eyelid recession surgery for lower eyelid retraction in thyroid orbitopathy.

Background/aims: Eyelid retraction in thyroid orbitopathy is traditionally managed with staged surgery after orbital decompression. We review the benefit of concurrent inferior retractor recession at the time of orbital decompression when closing a swinging-eyelid flap.

Methods: A retrospective, comparative, non-randomised clinical audit of 34 eyes of 22 patients with thyroid orbitopathy over a 3-year period was carried out. Patients were divided into a combined orbital decompression and inferior retractor recession (with lateral horn release) group (RG, n=13) and an orbital decompression non-recession group (NRG, n=21). Groups were matched for age, walls decompressed, volume of intraconal fat excised and improvement in exophthalmometry. Surgery involved one to three wall decompressions and intraconal fat excision via a swinging eyelid and transcaruncular approach. We report outcomes at 6 months based on postoperative standard photographs. Lower eyelid height, inferior scleral show and lower eyelid lateral flare were recorded by two blinded, independent assessors.

Results: The RG achieved a greater improvement in lower eyelid elevation (1.8 ± 0.8 mm) compared to the NRG (1.1 ± 0.8 mm) (p=0.042). The RG (58%) and NRG (40%) had improvement of lower lid lateral flare. Mean scleral show improved in both the RG (1.3 mm) and NRG (0.9 mm). No lower eyelid complications occurred.

Conclusion: Combining orbital decompression with concurrent inferior retractor recession at the time of swinging-eyelid flap closure is safe and improves lower lid height postoperatively compared to decompression alone.