The effect of orbital decompression on upper eyelid retraction
Reviewed by Hetvi Bhatt

This is a systematic review and meta-analysis on whether there is a change in upper lid retraction following orbital decompression. Traditional teaching states that the order of surgery for thyroid eye disease should be decompression firstly, followed by squint surgery and subsequently any lid surgery. The rationale behind this is that each prior step can impact any surgery that follows. This study includes 10 articles and excludes those where patients have been treated with steroids or orbital radiotherapy, the total number of orbits analysed being 688. The average decrease in margin to reflex distance (MRD-1) was 0.35mm (p=0.007) when conducting random-effect meta-analysis, which is statistically significant but not clinically so. The authors, therefore, conclude that this may be a reason to advocate for single stage decompression and lid surgery and quote several articles where this has been successfully demonstrated. It is an interesting proposition and one that could allow for quicker rehabilitation for thyroid eye disease and a potential reduction in waiting lists.

Influence of orbital decompression on upper eyelid retraction in Graves’ orbitopathy: a systematic review and meta-analysis.
Al-Qadi M, Hussain A.
ORBIT
2024;43(4):549–54.