Characteristics and Management of a Cohort of Patients with Asymmetric Thyroid Eye Disease and Unilateral Dysthyroid Optic Neuropathy Undergoing Unilateral Orbital Decompression Surgery

Background/Objectives: The aim was to describe the clinical characteristics and report the long-term outcomes of a cohort of patients with asymmetric thyroid eye disease (TED), including a subgroup with unilateral dysthyroid optic neuropathy (DON), treated with unilateral orbital decompression surgery alone or in combination with intravenous (IV) methylprednisolone. Methods: This retrospective study included 48 patients with asymmetric TED who all underwent orbital decompression with or without IV corticosteroid therapy between 2006 and 2020 at the Department of Ophthalmology and Optometry and Oral and Maxillofacial Surgery of the Medical University of Vienna, Austria. Results: The mean follow-up was 4.6 ± 2.6 years. Overall, 52% of the patients initially received IV corticosteroids followed by orbital decompression, and 73% underwent three-wall decompression. Mean visual acuity (VA) was 0.1 ± 0.5 logMAR at baseline and 0.1 ± 0.5 logMAR at final follow-up (p = 0.4). The mean reduction in proptosis was 4 ± 3 mm. Unilateral DON was diagnosed in 50% of the patients. In this subgroup, 67% were initially treated with IV corticosteroids and 79% underwent three-wall decompression. Mean reduction in proptosis was 5 mm. The final VA of the affected eye was <0.3 logMAR in 88% (21/24) of the patients with unilateral DON. Conclusions: Patients with asymmetric TED were predominantly treated with IV corticosteroids and received three-wall orbital decompression. Visual function could be maintained in a high number of cases with asymmetric TED and patients with unilateral DON.