Timing of surgery:
Surgical rehabilitation for TED is considered during the inactive phase following several months of stable measurements and controlled thyroid status (see Fig). Surgery may be necessary during the active phase when vision is threatened and includes orbital decompression for refractory DON or tarsorrhaphy and lid-narrowing procedures for corneal exposure.
Surgery for TED is staged sequentially:
- Orbital decompression
- Strabismus repair
- Eyelid surgery