Surgery in Thyroid Eye Disease.

The clinical manifestations of thyroid eye disease (TED) vary among patients and typically follow a biphasic course with active and inactive phases. Ocular proptosis, periorbital edema, eyelid retraction, orbital fat congestion, and infiltration causing fibrosis of enlarged extraocular muscles are several classic active phase signs. These changes may persist in the inactive phase, or regress only partially, necessitating reconstructive surgical intervention. In addition to cosmetic disfigurement, patients may develop strabismus, exposure keratopathy, and compressive optic neuropathy.1 Surgical rehabilitation in TED is complex, requiring a stepwise approach. Orbital decompression, followed by strabismus surgery, followed by eyelid surgery, is the accepted sequence of surgical intervention, as each step may affect the next.1