Though enlargement of the bony orbit by orbital decompression surgery has been known for about a century, surgical techniques vary all around the world mostly depending on the patient's clinical presentation but also on the institutional habits or the surgeon's skills. Ideally every surgical intervention should be tailored to the patient's specific needs. Therefore the aim of this paper is to review outcomes, hints, trends, and perspectives in orbital decompression surgery in thyroid eye disease regarding different surgical techniques. 1. Introduction Thyroid-associated orbitopathy (TAO) can be functionally disabling and, in severe cases, may result in permanent visual loss. It may also cause significant facial disfigurement. Although many authors use the term “cosmetic decompression,” it must be kept in mind that this in fact represents reconstructive surgery because it addresses an abnormality caused by a disease. While decompression surgery has the potential to improve facial appearance, patients should be carefully informed that it is often impossible to restore their look to what it has been before the disease began to modify the tissues involved. Frequently multiple surgical procedures are required, ranging from orbital decompression surgery via strabismus surgery to lid surgery, again emphasizing that these procedures are not performed for the purpose of “beautification” [1]. It is important to note that most TAO patients will not require surgical treatment. In 1996 Bartley et al. [2] demonstrated that only 20% of their patients had one or more surgical procedures. The cumulative probability of having surgery was initially 5% by 1 year after first diagnosis of the disease, rising to 9.3% by 2 years, to 15.9% by 5 years, and to 21.8% by 10 years. The need for surgery was significantly related to age, with a 2.6 times greater overall risk in patients older than 50 years. Medical (immunosuppressive) measures are the first-line treatment in the active stage of TAO. In the in-active stage of the disease or if medical therapy fails in sight threatening situations in active eye disease, the surgeon will be called upon to improve the patient’s condition. This paper aims to review historical aspects and recent advances in decompression surgery in thyroid associated orbitopathy. 2. Clinical Findings and Indications for Orbital Decompression Treatment of TAO requires an accurate assessment of disease activity, temporal progression, and severity. The aim of diagnosis is to differentiate the active stage—which represents a potential threatening of visual
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