Thyroid-associated orbitopathy (TAO), also known as thyroid eye disease (Graves or 'eye disease), is the most common specific inflammatory disease of the orbit (eye socket) and periorbital tissues. Management TAO includes both surgical and medical components.
TAO is associated with thyroid disease gland Graves' and may present at any time during the disease, whether the patient is euthyroid (normal thyroid gland), hypothyroid (underactive), or hyperthyroid (hyper) state.
The cause of TAO is unknown. In theory, Supports the immune system inflammation focused on building around the eye. Extraocular muscles (muscles that move the eye) are the primary site inflammation. Orbital fat and muscles of the eyelids are also commonly involved.Â
Demographically, TAO is the most prevalent among middle-aged Caucasian women, even if it occurs in all races. It is especially rare among Asians. Although less frequently affected men tend to be more severe course than women.
There are two phases of thyroid-related orbitopathy. active, inflammatory phase may last from 6 months to 5 years. Signs and symptoms change or progress over weeks months. not active, post-inflammatory phase begins when the symptoms have remained stable for at least 6 months.Â
Signs and symptoms of thyroid-related orbitopathy include: lid retraction (especially the side flash) cause "of the thyroid gland, view, dry eye syndrome, periorbital edema (swelling), swelling of the eye (swampy, watery eyes), restrictive strabismus with diplopia, proptosis (bulging eyes), and loss of vision due to compressive optic neuropathy (damage to the optic nerve - optic nerve connects the eye to the brain). Â
active phase of thyroid-related managed corneal lubrication (artificial tears), oral corticosteroid (prednisone), corticosteriod injection into orbit, orbital radiation, and in exceptional cases of optic nerve compression, orbital decompression.
Generally, the surgical treatment reserved for post-inflammatory or non-active phase of the disease, except for the vision-threatening diseases (eg optic neuropathy or severe corneal exposure) are present.Â
Signs and symptoms of non-active phase is cap appeal, exposure keratopathy, restrictive strabismus (tightness and pulling sensation in the eye movements causing double vision), proptosis and compressive optic neuropathy with vision loss.
If mild to moderate, may require management artificial tears. If severe, then surgery is usually required. TAO surgical procedure must be followed by a staged sequence procedures: a
Orbital Decompression
Strabismus Repair
Correction of eyelid retraction
Given the variable nature of the TAO, surgery to repair disease-related functional abnormalities are carefully timed and individual. Although Not all stages are necessary for each patient, orbital decompression is performed first, followed by strabismus correction, and finally, fix the lid retraction.Â
1.A Orbital Decompression Orbital decompression, if necessary, performed the first surgical production TAO. There are several indications for orbital decompression in patients with TAO: compressive optic neuropathy, exposure keratopathy due to proptosis, orbital pain, increased intraocular pressure, and cosmetic deformity.Â
Orbital decompression in TAO are achieved removal of orbital bone wall and / or orbital fat. Removal of one or more of the bone walls of the orbit expands capacity available orbital fat and extraocular muscles. Â
Typically balanced orbital decompression performed, which includes the removal lateral orbital wall (outside wall) and media orbital wall (inside walls), along with orbital orbital fat. surgeon removes the side wall through superior eyelid crease incision and removes the middle wall otolarygologist endoscopic approach through the nose. Usually, both processes are in the same operation. This is a major operation that requires general anesthesia and usually overnight hospital stay.Â
2.A Strabismus Correction The aim of treatment is surgical removal of double vision completely, but rather move Single binocular vision in more functional areas (straight and down). Given the unpredictability of limited extraocular muscles, surgery is usually performed with adjustable sutures. Adjustable sutures allow the adaptation of the eyes in fine-tuned in the postoperative period - when the patient is awake and alert, thereby improving the final surgical outcome.Â
3.A eye Correction Retraction Upper lid retraction may cause symptoms of dry eye-a corneal exposure, and may even cause an ulcer cornea due to insufficient closure of the lid. It also contributes to the cosmetic deformity. Given the tendency for spontaneous improvements, surgery for isolated upper eyelid retraction is usually done only after at least one year of observation. Â
Retraction of eyelid surgery is performed after the decompression and strabismus operations were completed and the lid position was stable for six months or more. Â
Upper lid retraction is corrected with levator recession operation. levator muscle (the muscle that lifts the lid) is prolonged This allows the upper lid to cover more eye. Can your answer to this operation as opposed ptosis (drooping eyelid) repair. Â
Lower eyelid retraction is a common problem in patients TAO ". Patients with lower eyelid retraction complain of tearing, dryness and foreign body sensation. They often have evidence of exposure keratopathy. The most commonly used method of elevating the lid covers location of tissue spacer in the rear area of the eyelids, thus effectively prolonging the lower lid.
Thyroid Eye Disease: Repair upper of lid retraction w scleral graft
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