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Updated: Nov 13, 2025

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Correlation between uniocular deviation and duction changes following different decompression surgeries in thyroid

Jie Guo1,2,3, Xiaofeng Li1,2,3, Ruiqi Ma1,2,3

  • 1Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University, Shanghai, China.

BMC Ophthalmology
|March 13, 2021
PubMed
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Orbital decompression surgery for thyroid eye disease can cause ocular imbalance. More extensive decompression (2- and 3-wall) significantly alters eye deviation and muscle function, potentially due to increased rectus muscle force.

Area of Science:

  • Ophthalmology
  • Surgical Anatomy
  • Biomechanics

Background:

  • Postoperative ocular imbalance is a significant complication of orbital decompression surgery for thyroid eye disease (TED).
  • Understanding the impact of different decompression techniques on ocular alignment and motility is crucial for patient outcomes.

Purpose of the Study:

  • To evaluate changes in unilateral ocular deviation and duction after 1-wall, 2-wall, and 3-wall orbital decompression in TED patients.
  • To explore the biomechanical factors contributing to postoperative ocular imbalance.

Main Methods:

  • Fifty-four TED patients undergoing unilateral orbital decompression were analyzed.
  • Patients were stratified by decompression extent: 1-wall (n=15), 2-wall (n=18), and 3-wall (n=21).
  • Ocular deviation (prism test, synoptophore) and ductions (Hirschberg's method) were assessed; extraocular rectus muscle diameters were measured via CT.
Keywords:
Ocular ductionOrbital decompressionStrabismusThyroid eye disease

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Main Results:

  • No significant changes in deviation or duction were observed after 1-wall decompression.
  • 2-wall decompression led to increased esotropia and altered adduction/abduction (p<0.05).
  • 3-wall decompression resulted in increased hypotropia, infraduction, and altered adduction/abduction (p<0.05).
  • Increased esotropia correlated with changes in adduction/abduction; medial rectus diameter correlated with deviation and duction changes.

Conclusions:

  • Orbital decompression extent significantly influences postoperative ocular deviation and duction.
  • Increased contractile force of rectus muscles may be a primary driver of strabismus changes following decompression surgery.