Thyroid associated orbitopathy following periocular surgery

Double Vision After Minimally Invasive Orbital Decompression

INTRODUCTION

New onset Diplopia following orbital decompression in thyroid eye disease patients is estimated to occur in up to 30% to 40% of decompression patients, mostly related to deep lateral and medial wall decompressions.

METHODS

A retrospective chart review of all minimally invasive (fat and minimal bone orbital decompression performed at the UCLA Stein Eye Institute between 2005 and 2015. Inclusion criteria were thyroid eye disease patients older than 18 years undergoing fat only orbital decompression with no previous muscle surgery.

RESULTS

The chart review revealed only 5 patients with new onset diplopia after this surgery. The cases are discussed and a possible mechanism for the diplopia is proposed.

DISCUSSION

Double vision following minimally invasive orbital decompression is rare and the mechanisms are poorly understood.

Reactivation of thyroid associated orbitopathy following trauma with intraorbital foreign body

A 63-year-old female with mild, bilateral, stable thyroid-associated orbitopathy sustained trauma resulting in glass foreign bodies embedded on the left ocular surface and left lateral orbital extraconal and intraconal space. After 2 orbitotomies including a failed attempt to remove the intraconal foreign body and poor response to oral steroids, she developed severe, progressive left periorbital edema and 9 mm of relative proptosis. Serial, post-operative imaging demonstrated worsening inflammatory changes along the surgical tract, which slowly improved over several months, with simultaneously worsening proptosis and enlargement of the left inferior and medial rectus muscles consistent with worsening thyroid orbitopathy. She subsequently underwent unilateral 3-wall orbital decompression with improvement in her symptoms. Periorbital trauma with orbital foreign bodies and related surgical trauma may result in reactivation of thyroid-associated orbitopathy.

Development of thyroid-related orbitopathy following cataract surgery

AIM

To report a case series of patients who had manifestation or aggravation of thyroid related orbitopathy (TRO) following cataract surgery in an Asian eye centre.

METHODS

A systematic review of clinical records of patients with manifestation or aggravation of TRO was conducted. Inclusion criteria were manifestation or aggravation of TRO within 6 months of cataract surgery.

RESULTS

Five patients treated for TRO at Singapore National Eye Centre from January 2007 to December 2008 were included in the study. There were 2 males and 3 females with mean age of 54.6 years (range 51-86). Surgery included phacoemulsification with implantation of intraocular lens. The mean interval between surgery and manifestation of symptoms was 7.4 weeks. Contralateral eye involvement was seen in all patients. Clinical presentation of orbitopathy ranged from increased soft issue swelling, proptosis and progression of myopathy to compressive optic neuropathy. One patient had total loss of vision. Mean follow-up was 21 months (range 2-60).

CONCLUSION

TRO can present shortly after cataract surgery and lead to serious vision threatening complications. Patients will need to be counseled pre-operatively regarding the risk of post-operative period.