Changes in Eyelid Parameters after Orbital Decompression according to the Surgical Approach in Thyroid Eye Disease

PURPOSE: To evaluate the changes in eyelid parameters after the endonasal approach compared with transcaruncular medial wall decompression combined with the transconjunctival inferior wall decompression approach with inferomedial strut preservation. METHODS: In total, 71 patients with thyroid eye disease who underwent orbital decompression were retrospectively evaluated. The data collected included Hertel exophthalmometry, marginal reflex distance 1, marginal reflex distance 2, interpalpebral fissure, levator function test measures, and complications related to surgery. RESULTS: Proptosis reduction produced a statistically significant improvement across all decompression groups. Lower eyelid retraction produced a statistically significant improvement in the two-wall decompression groups but not in the one-wall decompression groups. No statistical difference was observed in the upper eyelid retraction and levator function after surgery across all decompression groups. In the post-hoc analysis, statistical improvement was not observed in the lower eyelid retraction between the endonasal and transcaruncular approach in the one-wall and two-wall decompression groups, although statistically significant exophthalmos reduction and improvement in the lower eyelid retraction was noted in the two-wall decompression subgroups compared with one-wall decompression subgroups. CONCLUSIONS: Our study showed no differences in eyelid parameters between the endonasal and transcaruncular decompression approaches in one-wall and two-wall decompression. In the two-wall decompression group, proptosis reduction was greater with the endonasal approach than with the transcaruncular approach when the strut was preserved; however, it does not lead to a significant difference in the improvement of lower eyelid retraction.