Advances in surgical rehabilitation in thyroid eye disease

Background: Surgery has evolved over the past 20 years. Conceptual and technical advances have helped improve the surgical rehabilitation of Graves' orbitopathy. A historical comparison of methods and approaches has shown clear progress. Summary: Surgical rehabilitation of Graves' orbitopathy is traditionally staged: orbital decompression, extraocular muscle surgery, eyelid repositioning, and the soft tissue volume and redraping. Improvements in techniques have evolved from the problems that historical methods have presented, and an evaluation of each will help appreciate the improvements that have been made for patient care. Conclusion: Incremental improvements in surgery for thyroid eye disease have been made over the past 20 years. However, thyroid-related orbitopathy will always be limited by fibrotic and structural changes that may be camouflaged by surgery, but never cured. Future advances in medical management will be derived from the laboratory.