Intravenous methylprednisolone should be considered perioperatively to guard against this as well as close monitoring in the early postoperative period. Furthermore, surgery does not prevent the new development of dysthyroid orbitopathy or other sight-threatening complications such as exposure keratophathy and hence patients need to be counselled about this and followed up appropriately.
Dysthyroid optic neuropathy can be a rapidly progressive and blinding condition, but with adequate immunosuppression and surgery the visual outcomes can be excellent.
A pertinent lesson from our series is the importance of patient trust, understanding, and cooperation. In the one patient where there was poor compliance with treatment, the final visual outcome was poor.
We found that squint surgery following orbital decompression does not undo the decompression effect as we suspected it might we had presumed that the recession surgery on rectus muscles may cause the globe to lux forward and thus undo the reduction in proptosis caused by decompression surgery. Instead, there was a significant reduction in exophthalmometry readings post squint surgery that is likely because of a tendency for the decompression effect to increase over time in spite of squint surgery.
This study is not without its limitations. It presents a retrospective case review of orbital decompressions from a service evaluation of patients under the care of a single surgeon. As such, the transferability of the data needs to be taken with care. It is for this reason that we have put our results within the context of the wider literature on the subject through systematic literature searching.
Our literature search showed a vast array of differing surgical approaches from around the world Table 5. We limited our literature search to the past 10 years as techniques have evolved considerably in this time period such that older studies become increasingly less meaningful.
Lateral wall decompression results were similar to ours in the current series with decompression effects of 3. We suspect that the widely differing reports of postoperative numbness are because of the variable reporting and questioning about this generally mild postoperative symptom. The other bony decompressions endoscopic or external had decompression effects between 1.
A Cochrane review of orbital decompressions found only one randomised control study comparing two types of surgery. Neither of these techniques is any longer employed in wide clinical practice. As such, the evidence base behind our decision making for decompressions in TED lies very much within expert opinion and the case series' detailed in Table 5. Assimilation of these case series here will hopefully guide decision making and direct future prospective studies.
In summary, surgical orbital decompressions are an established procedure for the management of certain patients with TED. Lateral decompressions are safe and effective for hydraulic TED and stable proptosis and have low complication rates.
Where there is severe proptosis, two-and-a-half wall decompression may be more suitable, but the risk of new postoperative diplopia is higher. For dysthyroid optic neuropathy not responding to immunosuppression, medial one-and-a-half wall decompression is usually the surgery of choice and has good results in restoring visual function where there is good patient compliance and understanding.
Baldechi L Orbital decompression. Outcome of orbital decompression for disfiguring proptosis in patients with Graves' orbitopathy using various surgical procedures.
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Thyroid ; 22 11 : — The majority of the healing in your nose will take place over the next four weeks. In some patients, the process can take longer. You should have received prescriptions for medications to take after surgery.
Typically, these include pain medicine and possibly antibiotics. These medications are essential components of your care, promoting rapid and correct healing. Nausea and even vomiting following anesthesia are common.
The nausea usually fades after about hours. You can try to sip liquids to avoid dehydration during these periods. This is one of your most important jobs after surgery. The crusting of blood and mucus can slow the healing process.
To keep your nose moist and prevent crusting, you should use saline salt-water nasal irrigation following surgery. Fatigue for two or three days following the surgery is common. You will want to take it easy for a few days following surgery. You should also avoid strenuous physical activity. Moderate activity like going for a walk is acceptable. Most individuals return to work within a week following surgery. Some return earlier, some later. Plan to be out for a week and return as soon as you feel up to it.
Many of our patients travel from some distance. If possible, it is helpful to stay in the local area overnight following the surgery. If necessary, you may travel by air 48 hours after the surgery. The care of your sinuses and orbit surgery does not end when the surgery is completed. Post-operative visits are critical. During these visits, your physician will examine your nose. Removal of dried blood and mucus may be necessary while the nose regains its ability to care for itself.
If you are concerned about whether or not you could benefit from orbital decompression ENT surgery, please contact us to schedule an appointment. Our board-certified physicians have extensive experience in treating both common and complex cases to help adults and children alike. For more information or to schedule an appointment, contact us. American Academy of Ophthalmology. Nasal Problems , Sinus surgery. Skip to content Menu.
January 3, When would you need orbital decompression surgery? You would need this surgery if you have problems resulting from: An accident or injury A severe eye infection Tumors Graves disease What is Graves disease? Graves ophthalmopathy also presents problems such as Eye irritation and pain Excessive tearing Eye pressure Inflamed, red eyes Puffy eyelids Sensitivity to light Double vision Gritty sensation in the eyes In certain cases, Graves ophthalmopathy can cause vision loss.
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