Clinical course and prognosis of diplopias after orbital bony wall decompression or thyroid related orbitopathy

Introduction: The aim of this study was to assess how oculomotor complicati ons progress after orbital bony decompression for dysthyroid orbitopathy an d to assess the residual risk of consecutive diplopia. Material and methods: The medial orbital wall and floor were decompressed b y a transpalpebral approach in 77 patients (117 orbits). indications for de compression were optic neuropathy in 22 patients, exposure of the cornea in 1 patient, and cosmetic rehabilitation in 54 patients. Occurrence of oculo motor disorder after surgery was noted and the clinical course after a one- year follow-up was studied. Results: Diplopia was observed in 34 patients (44%), 18 of these patients w ere treated by external orbital radiotherapy before surgery. Diplopia decre ased spontaneously over a period ranging from 15 days to 2 months or was tr eated by adequate prism in 22 cases. A higher degree of diplopia (12 to 30 diopters) was noted in 12 cases, riquiring surgical care that was successfu l in all cases. This progress was especially observed in patients with opti c neuropathy or in patients who had been previously treated with external o rbital radiotherapy. Conclusion: Prognosis of diplopia after bony wall decompression for thyroid -related arbitopathy can be favorable with spontaneous reduction, prism, or surgical treatment. Precise information should be given to the patients be fore surgery.