Lateral Retrocanthal Orbital Decompression for Children With Thyroid Eye Disease: A Canthus-sparing Approach

Thyroid eye disease (TED) is one of the most common causes of proptosis in children. The traditional surgical approach to manage disfiguring proptosis associated with TED is orbital decompression surgery, which is often accomplished via lateral wall decompression through canthotomy and cantholysis. However, this technique can result in lateral canthus scarring and migration. Here, we describe the effectiveness of a skin-sparing retrocanthal transconjunctival surgical technique for lateral orbital decompression in pediatric patients with TED. Twelve pediatric patients with TED and disfiguring proptosis underwent lateral orbital decompression through a conjunctival-only incision at the Children's Hospital of Philadelphia from 2014 to 2024. The mean age at TED onset was 12.51 (range: 8.50-17.22) years, with surgery performed at a mean age of 14.80 years. A significant reduction in proptosis was observed postoperatively, with exophthalmometry measurements decreasing from 22 mm (SD: 3.09) to 19 mm (SD: 2.59) (P = 0.0001). Complications were minimal, with 1 case of postoperative diplopia and 1 case of a conjunctival cyst, both of which were managed effectively. No patients experienced optic neuropathy, eyelid malposition, or scarring. The skin-sparing retrocanthal transconjunctival approach for lateral orbital decompression in pediatric TED effectively reduces proptosis while minimizing the risk of scarring and other complications associated with traditional lateral canthotomy. This technique offers a promising alternative for managing disfiguring proptosis in children, providing significant cosmetic and functional benefits. Further studies with larger sample sizes are warranted to validate these findings.