Management of strabismus in thyroid eye disease

Abstract

Strabismus associated with thyroid eye disease results in significant impairment of daily activities and a decreased quality of life. Eye muscle surgery restores good ocular alignment and relieves diplopia in primary and reading gaze positions in more than 80 % of cases. Patients frequently undergo orbital decompression prior to eye muscle surgery. The most common patterns of strabismus include unilateral and bilateral inferior rectus restriction causing limited upgaze and unilateral or bilateral medial rectus tightness causing esotropia and limitation of abduction. Determining the amount of recession for tight muscles is difficult, and the response to a given amount of recession does not follow the nomograms that are utilized for nonrestrictive strabismus; this leads to the necessity of using adjustable suture techniques or other methods that allow for the positioning of the recessed muscle insertions based on intraoperative findings. The management of patients with TED and strabismus poses significant surgical challenges that are addressed in this chapter. General principles of evaluation are presented, and surgical techniques, pitfalls, and outcomes are described.