2023 Volume 116 Issue 9 Pages 877-880
Dysthyroid orbitopathy is an autoimmune inflammatory disease of the orbital tissues associated with Graves’ disease, and rarely, Hashimoto’s disease. Symptoms include diplopia, rabbit eyes, decreased visual acuity, and cosmetic problems, such as protruding eyeballs. Our department has been performing endoscopic transnasal orbital decompression for dysthyroid orbitopathy since 2015. Orbital decompression is performed to relieve pressure on the optic nerve in severe cases, and also to resolve cosmetic problems such as protrusion of the eyes in mild to moderate cases. Surgery is usually performed bilaterally, and there are very few reports of unilateral orbital decompression. Herein, we report performing an endoscopic transnasal orbital decompression procedure to improve eye closure difficulties and improve the appearance in an inactive, mild case with unilateral thyroid ophthalmopathy. The patient was an 18-year-old woman who was diagnosed as having Graves’ disease 6 years before her first visit to our department. She developed dysthyroid orbitopathy 3 years before her first visit to our department and was treated with steroid pulses and botox injections at the neuro-ophthalmology department. She had undergone total thyroidectomy 1 year before her first visit to our department. She was referred to our department and underwent right orbital decompression surgery. After the surgery, the protrusion of the eyeballs decreased by 3 mm, and the subjective symptom of difficulty in closing the eye also improved. Also, diplopia is the main postoperative complication of endoscopic transnasal orbital decompression. In this case, however, there was no diplopia.
Endoscopic transnasal orbital decompression is useful for the treatment of unilateral ocular protrusion due to dysthyroid orbitopathy, because it is minimally invasive and yields excellent cosmetic outcomes. For inactive cases such as this case, it is necessary to carefully balance the operation with the contralateral side after explaining the risk of postoperative diplopia to the patient. The patient should be carefully monitored for the appearance of symptoms of postoperative diplopia and worsening of activities in the future.
