Surgical treatment of strabismus in thyroid eye disease: characteristics, dose–response, and outcomes

Worawalun Honglertnapakul, Kara M. Cavuoto, Craig A. McKeown, Hilda Capó

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Purpose: To describe the surgical management, dose–response, and postoperative outcomes of strabismus surgery in patients with thyroid eye disease. Methods: The medical records of patients operated on between 2014 and 2018 were reviewed retrospectively. Patient characteristics and surgical data were collected. Motor success was defined as vertical deviation of ≤5Δ and horizontal deviation of ≤10Δ; sensory success, as no diplopia in primary gaze. Results: A total of 76 patients (mean age, 62.2 ± 12.9 years; 50 females) underwent 87 surgeries, most commonly unilateral inferior rectus recession (unilateral IR, 48%) and bilateral medial rectus recession (bilateral MR, 23%). Motor success was achieved in 69% and sensory success in 58%. For unilateral IR surgery, the dose–responses were 3.25Δ/mm (SE = 0.616; β = 0.650; P < 0.001) at distance and 2.48Δ/mm (SE = 0.752; β = 0.472; P = 0.002) at near; for bilateral MR surgery, 3.93Δ/mm (SE = 0.997; β = 0.680; P = 0.001) at distance and 5.05Δ/mm (SE = 1.374; β = 0.655; P = 0.002) at near. Median (Q1, Q3) postoperative drift was toward overcorrection for both procedures (unilateral IR, −2Δ [−8, 0] at distance and −2Δ [−7, 0] at near; bilateral MR, −2Δ [−8, 2] at distance and −2Δ [−10, 0] at near). Sex, age, duration of strabismus, prior orbital decompression, and concurrent vertical and horizontal procedures were not associated with dose–response or postoperative drift. Conclusions: Concurrent vertical and horizontal surgery did not affect the motor success rate, dose–response, or postoperative drift. Although unilateral IR surgery had a larger dose–response at distance, bilateral MR surgery had a larger dose–response at near. Most procedures tended to have a postoperative drift toward overcorrection.

Original languageEnglish (US)
Pages (from-to)72.e1-72.e7
JournalJournal of AAPOS
Issue number2
StatePublished - Apr 2020

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Ophthalmology


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