Análise das características clínicas e alterações de motilidade ocular dos pacientes com orbitopatia de graves submetidos a cirurgia de descompressão orbitária em hospital universitário da Bahia

Abstract

Introduction: Graves orbitopathy is the most common extrathyroidal manifestation of Graves disease and frequently results in functional and esthetic impairment. Alterations of ocular motility are common, may be exacerbated after orbital decompression surgery, and significantly impact patients’ quality of life. Objective: To describe the clinical characteristics and the evolution of ocular motility alterations in patients with chronic Graves orbitopathy undergoing orbital decompression at a university hospital in Bahia, Brazil, between 2017 and 2023. Methods: Retrospective, cross-sectional, observational study based on electronic medical records. Data collected included demographics, subtype of thyroid eye disease, surgical technique, pre- and postoperative ocular motility findings, presence of diplopia, and need for strabismus surgery. Patients operated during the active phase or with insufficient follow-up were excluded. Results: Twenty-three patients met inclusion criteria; 78% were female and the most prevalent age group was 40–49 years. The mixed subtype of Graves orbitopathy predominated (73.9%). Preoperative ocular motility alterations were present in 52.2% of patients, mostly mixed deviations, particularly esotropia associated with hypotropia. After orbital decompression, 18.2% of patients previously without deviation developed new-onset strabismus, while 58.3% of those with preoperative deviation maintained their pattern and 33.3% worsened. Only one patient showed complete improvement. No statistically significant difference was found between pre- and postoperative motility alterations (McNemar p = 0.564). Among those with postoperative deviations, 46.1% received indication for strabismus surgery, with 50% success rate among those who underwent the procedure. Conclusion: Ocular motility disturbances were frequent in this population, especially in patients with the mixed subtype of Graves orbitopathy. Orbital decompression did not significantly modify the overall rate of motility alterations and, in some cases, induced or worsened strabismus. These findings highlight the importance of detailed preoperative counseling, systematic evaluation of ocular motility, and planning of sequential management, including potential need for strabismus correction.