Strabismus Surgery in Thyroid-Related Eye Disease: Strategic Decision Making

Thyroid-related eye disease represents a unique clinical spectrum of autoimmune inflammation of the orbital tissues. The exact immunopathogenesis is still not fully elucidated, and the disease can sometimes manifest itself as a chronic and unrelenting condition with complex interplay between environmental, genetic, and immune factors. The inflammatory changes result in alterations to muscle anatomy and physiology as well as iatrogenic alterations preceding surgical intervention; therefore, the response to conventional surgical doses in strabismus surgery is not predictable. This unpredictability is exacerbated by an evolving clinical picture that may result in new-onset deviations despite an initial good surgical outcome. Management of strabismus in patients with thyroid-related eye disease can be challenging. This review discusses the various surgical options available, their success rates, and the complications. This strategic decision-making will aid the ophthalmologist in choosing among possible options for these patients and counseling them accordingly.