Comprehensive surgical management of proptosis in dysthyroid orbitopathy

During the last ten years, particularly since the advent of computerized tomography, the diagnosis of dysthyroid orbitopathy has become the subject of intense interest. Since dysthyroid orbitopathy is an undefined immune disorder, current treatment is directed at combating the effects of the disease rather than attacking its etiology. Medical treatment and radiation therapy have important roles in the management of dysthyroid orbitopathy. especially in the acute congestive phase. Management of the more severe chronic manifestations is primarily surgical.A comprehensive approach to the surgical management of proptosis in dysthyroid orbitopathy is presented from experimental and clinical experience. the lid masking procedures for proptosis are reviewed and selection process has been described. A technique of tarsal conjunctival upper to lower lid transplantation has been presented experimentally and clinically to elevate the lower lid margin using autogenous graft material. the various methods of orbital decompression are reviewed, and comprehensive method for selecting and performing orbital decompression is presented based on experimental and clinical experience. the indications and complications of the procedures recommended have been described.It is our intention to present case for the development of comprehensive approach to managing dysthyroid orbitopathy. This approach emphasizes individualization of management of dysthyroid proptosis, with or without optic neuropathy, by lid masking and orbital decompressive procedures.