Surgical Orbital Decompression for Thyroid Eye Disease

There is insufficient evidence from controlled trials on the best surgical approach for orbital decompression in the treatment of proptosis in adult thyroid eye disease. Level of evidence: "D"

Comment: The quality of evidence is downgraded by study limitations, byinconsistency (variability in results) and byimprecise results (few patients for each comparison).

Summary

A Cochrane review [Abstract] 1 on surgical orbital decompression for proptosis in adult thyroid eye disease included 2 studies. One study suggested that the transantral approach (26 eyes in 17 participants) and endoscopic transnasal technique (18 eyes in 18 participants) had similar effects in reducing exophthalmos but that the endoscopic approach may be safer, relating to fewer complications. Follow-up time was short and there was no information on the primary outcome, success or failure of treatment. The second study with a small sample size (6 participants in the surgical, 9 in the medical group) provided evidence that intravenous steroids may be superior to primary surgical decompression in the management of compressive optic neuropathy requiring less secondary surgical procedures, although it relates more frequently to transient side effects.