gms | German Medical Science

102. Jahrestagung der DOG

Deutsche Ophthalmologische Gesellschaft e. V.

23. bis 26.09.2004, Berlin

Ocular Muscle Surgery in Endocrine Orbitopathy

Meeting Abstract

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  • corresponding author U.H. Grenzebach - Klinik und Poliklinik für Auenheilkunde am Universitätsklinikum Münster

Evidenzbasierte Medizin - Anspruch und Wirklichkeit. 102. Jahrestagung der Deutschen Ophthalmologischen Gesellschaft. Berlin, 23.-26.09.2004. Düsseldorf, Köln: German Medical Science; 2004. Doc04dogFR.17.05

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Veröffentlicht: 22. September 2004

© 2004 Grenzebach.
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Chronic inflammation of the intraorbital connective tissues followed by restriction of ocular muscle elasticity due to fibrosis and deposits of glycosaminoglycans, are the main reasons for motiity disorders in endocrine orbitopathy. The restriction of ocular motility is often symmetric and is found with decreasing frequency in the inferior rectus muscle, the medial rectus muscle, the superior rectus muscle and in the lateral rectus muscle. Symptoms of motility disorders are blurred vision, intermittent or persisting diplopia. Diplopia in minor defects is susceptible to correction with prism glasses. Major defects in motility restriction and perception of diplopia require ocular muscle surgery.


Stabilisation of hypertyroidism with hormone levels within the upper range of normality, no acute inflammatory symptoms, stable strabismus angles for more than 6 months. Examination of strabismus angles in different globe positions measured by the alternate prism cover test, examination of monocular excursions und examination of fusion in different gaze positions.

Surgical procedures

The main surgical procedures consist in simple muscle recession with fixation of the muscle or recession with adjustable sutures. In a limited number of cases a combination of the above mentioned procedures with a resection of the antagonist or with a myopexy of the contra-lateral antagonist can be performed.


Angles up to 15° can be corrected by recession of the fibrotic muscle alone. Surgery with fixed suteres lead more often to slight undercorrection, while frequently, surgery with adjustable sutures result in overcorrection. Improvement in ocular motility and head posture as well as improvement in fusion field can be achieved with all methods mentioned above.