Clinical Outcomes of Orbital Fat Decompression in Pediatric Thyroid Eye Disease: A Two-Center Retrospective Study

To evaluate the clinical outcomes and safety of orbital fat decompression in pediatric patients with thyroid eye disease (TED).

This retrospective two-center study included pediatric patients (≤17 years; achieved age range 12-17 years) with inactive, non-sight-threatening TED (Clinical Activity Score 0-1) who underwent orbital fat decompression between June 2017 and February 2025 at two centers in Japan. Patients with follow-up <3 months, prior orbital decompression, or additional eyelid surgery within 3 months were excluded. Outcomes assessed included Hertel exophthalmometry, lower scleral show, diplopia, and postoperative complications.

Twenty patients (39 eyes) were included. Mean proptosis was significantly reduced after surgery (p < 0.001), with a combined mean reduction of 2.36 mm (95% CI 1.97-2.75 mm; right eye 2.30 mm, left eye 2.39 mm). Lower scleral show improved in 84.2% of patients, with complete resolution in 63.2%; outcomes were similar after excluding three patients who underwent concomitant lower eyelid fat grafting. Subjectively perceived diplopia was documented in 5 patients (25%) on postoperative day 1 and persisted at 1 month in 2 patients (10%); all cases resolved by final follow-up with no persistent or de novo symptomatic diplopia. Mydriasis occurred in 4 patients (20%), resolving completely in 3, with mild asymptomatic residual pupillary asymmetry in 1 patient at final follow-up. No vision-threatening complications, visual acuity loss, infections, or wound-related complications occurred.

Orbital fat decompression via a sutureless transconjunctival approach achieved clinically meaningful and statistically significant improvement in proptosis and lower eyelid position in pediatric TED, with generally self-limiting complications and no vision-threatening adverse events, although mild asymptomatic pupillary asymmetry persisted in one patient at final follow-up. These findings support orbital fat decompression as a viable surgical option in pediatric patients, although they should be confirmed in larger, prospective, multicenter studies with longer follow-up.