Skip to main content Accessibility help

Orbital decompression surgery for thyroid eye disease: implications for anaesthesia

  • L. Stannard (a1), R. M. Slater (a1) and B. Leatherbarrow (a2)



The management of thyroid-associated eye disease is reviewed with particular reference to surgical management and its implications for anaesthetists. Experience from a unit undertaking such surgery is presented.


Corresponding author

Correspondence to: Roger Slater, Anaesthetic Department, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK. E-mail:; Tel: +44 1612 76 4551; Fax: +44 1612 76 8072


Hide All


Farling PA. Thyroid disease. Br J Anaesth 2000; 85: 1528.
Weetman AP. Thyroid-associated eye disease: pathophysiology. Lancet 1991; 338: 2528.
Tunbridge WMG, Everend DC, Hall R et al. The spectrum of thyroid disease in a community: the Whickham survey. Clin Endocrinol 1977; 7: 481493.
Jacobson DH, Gorman CA. Endocrine ophthalmopathy: current ideas concerning etiology, pathogenesis and treatment. Endoc Rev 1984; 5: 200220.
van der Wal KGH, de Visscher JGAM, Boukes RJ, Smeding B. Surgical treatment of Graves orbitopathy: a modified balanced technique. Int J Oral Maxillofac Surg 2001; 30: 254258.
Marcocci C, Bartalena L, Bogazzi F, Panicucci M, Pinchera A. Studies on the occurrence of ophthalmopathy in Graves' disease. Acta Endocrinol 1989; 120: 473478.
Perros P, Crombie AL, Matthews JNS, Kendall-Taylor P. Age and gender influence the severity of thyroid-associated ophthalmopathy: A study of 101 patients attending a combined thyroid-eye clinic. Clin Endocrinol 1993; 38: 367372.
Bartley GB, Fatourechi V, Kadrmas EF et al. The incidence of Graves' ophthalmopathy in Olmsted County, Minnesota. Am J Ophthalmology 1995; 120: 511517.
Atabay C, Tyutyunikov A, Scalise D. Serum antibodies reactive with eye muscle membrane antigens are detected in patients with non-specific orbital inflammation. Ophthalmology 1995; 102: 145153.
Prummel MF, Suttorp SM, Wiersinga WM, Verbeck AM, Mourits MP, Koornneef L. A new ultrasonographic method to detect disease activity and predict response to immunosuppressive treatment in Graves' ophthalmopathy. Ophthalmology 1993; 100: 556561.
Weetman AP, Cohen S, Gatter KC, Fells P, Shine B. Immunohistochemical analysis of the retro-bulbar tissues in Graves' ophthalmopathy. Clin Exp Immunol 1989; 75: 222227.
Rundle FF, Wilson CW. Development and course of exophthalmos and ophthalmoplegia in Graves' disease with special reference to the effect of thyroidectomy. Clin Science 1945; 5: 177194.
Solomon DH, Chopra IJ, Chopra U, Smith FJ. Identification of subgroups of euthyroid Graves' ophthalmopathy. New Engl J Med 1977; 296: 181185.
Lazarus JH. Relation Between Thyroid Eye Disease and Type of Treatment of Graves' Hyperthyroidism. Thyroid 1998; 8: 437.
Carey C, Skosey C, Pimmananeni KM, Barsona CP, DeGroot L. Thyroid abnormalities in children of parents who have Graves' disease: possible pre-Graves' disease. Metabolism 1980; 29: 369376.
Villanueva R, Inzerillo AM, Tomer Y et al. Limited genetic susceptibility to severe Graves' ophthalmopathy: no role for CTLA-4 but evidence for an environmental etiology. Thyroid 2000; 10: 791798.
Hadden DR, McDevitt A. Environmental stress and thyrotoxicosis: absence of an association. Lancet 1974; 2: 577578.
Winsa B, Adamii HO, Bergstrom R. Stessful life events and Graves' disease. Lancet 1991; 338: 14751479.
Prummel MF, Wiersinga WM. Smoking and risk of Graves' disease. JAMA 1993; 269: 479482.
Pfeilschifter J, Ziegler R. Smoking and endocrine ophthalmopathy: Impact of smoking severity and current vs. lifetime cigarette consumption. Clin Endocrinol 1996; 45: 477481.
Mann K. Risk of smoking in thyroid-associated orbitopathy. Exp Clin Endocrinol Diabetes 1999; 107: 164167.
Tallstedt L, Lundel G, Taube A. Graves' ophthalmopathy and tobacco smoking. Acta Endocrinol 1993; 129: 147150.
Anonymous. Classification of eye changes of Graves' disease. Thyroid 1992; 2: 235236.
Utech CI, Khatibnia U, Winter PF, Wulle KG. MR T2 relaxation time for the assessment of retro-bulbar inflammation in Graves' ophthalmopathy. Thyroid 1995; 5: 185193.
Bailey CC, Kabala J, Laitt R et al. Magnetic resonance imaging in thyroid eye disease. Eye 1996; 10: 617619.
Neigel JM, Rootman J, Belkin RI et al. Dysthyroid optic neuropathy: The crowded orbital apex syndrome. Ophthal-mology 1988; 95: 15151521.
Kendler DL, Lippa J, Rootman J. The initial clinical characteristic of Graves' orbitopathy vary with age and sex. Arch Ophthal 1993; 111: 197201.
Perros P, Kendall-Taylor P. Medical Treatment for Thyroid-Associated Ophthalmopathy. Thyroid 2002; 12: 241244.
Burch HB, Wartofsky L. Graves' ophthalmopathy: current concepts regarding pathogenesis and management. Endocr Rev 1993; 14: 747793.
Claridge KG, Ghabrial R, Davis G et al. Combined radiotherapy and medical immunosuppression in the management of thyroid eye disease. Eye 1997; 11: 717722.
Werner SC. Prednisone in emergency treatment of malignant exophthalmos. Lancet 1966; 1: 1000410007.
Kendall-Taylor P, Crombie AL, Stephenson AM, Hardwick M, Hall K. Intravenous methylprednisolone in the treatment of Graves' ophthalmopathy. Br Med J 1988; 297: 15741578.
Bartelena L, Marcocci C, Chiovato L et al. Orbital cobalt irradiation combined with systemic corticosteroids for Graves' ophthalmopathy: Comparison with systemic corticosteroids alone. J Clin Endocrinol Metab 1983; 56: 11391144.
McCord CD. Current trends in orbital decompression. Ophthalmology 1985; 92: 2131.
Leone CR, Piest KL, Newman RJ. Medial and lateral wall decompression for thyroid ophthalmopathy. Am J Ophthalmol 1989; 108: 160166.
Fatourechi V, Garrity JA, Bartley GB. Graves' ophthalmopathy: results of transantral orbital decompression performed primarily for cosmetic indications. Ophthalmology 1994; 101: 938942.
Garrity JA, Fatourechi V, Bergstralh EJ et al. Results of transantral orbital decompression in 428 patients with severe Graves' ophthalmopathy. Am J Ophthalmol 1993; 116: 533547.
Shorr N, Neuhaus RW, Baylis HI. Ocular motility problems after orbital decompression for dysthyroid ophthalmopathy. Ophthalmology 1982; 89: 323328.
Mourits MP, Koornneef L, Wiersinga WM, Prummel MF, Berghout A, van der Gaag R. Orbital decompression for TAO by inferomedial, by inferomedial plus lateral, and by coronal approach. Ophthalmology 1990; 97: 636641.
Hutchinson BM, Kyle PM. Long-term visual outcome following orbital decompression for dysthyroid eye disease. Eye 1995; 9: 578581.
Tallstedt L, Papatziamos G, Lundblad L, Anggard A. Results of transantral orbital decompression in patients with thyroid-associated ophthalmopathy. Acta Ophthalmol Scand 2000; 78: 206210.
McNab AA. Orbital decompression for thyroid orbitopathy. Aust N Z J Ophthalmol 1997; 25: 5567.
Paridaens D, Hans K, van Buitenen S, Mourits MP. The incidence of diplopia following coronal and translid orbital decompression in Graves' orbitopathy. Eye 1998; 12: 800805.
Linnet J, Hegedus L, Bjerre P. Results of a neurosurgical two-wall orbital decompression in the treatment of severe thyroid associated ophthalmopathy. Acta Ophthalmol Scand 2001; 79: 4952.
Michel O, Oberlander N, Neugebauer P, Neugebauer A, Rubmann W. Follow-up of transnasal orbital decompression in severe Graves' ophthalmopathy. Ophthalmology 2001; 108: 400404.
Goldberg RA, Weinberg DA, Shorr N, Wirta D. Maximal, three-wall, orbital decompression through a coronal approach. Ophthalmic Surg Lasers 1997; 28: 832843.


Related content

Powered by UNSILO

Orbital decompression surgery for thyroid eye disease: implications for anaesthesia

  • L. Stannard (a1), R. M. Slater (a1) and B. Leatherbarrow (a2)


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.