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Superior medial fat decompression for thyroid eye disease

Orbital decompressions can be performed with boney decompressions, fat decompressions, or a combination of the two. Fat decompressions most commonly involved the inferior lateral fat; however, the inferior medial and superior medial fat compartments can also be addressed. In this video, a medial eyelid crease incision is used to gain access to the superior medial fat compartment. A written transcript of this video is as follows: This is Richard Allen at oculosurg.com. This video demonstrates a fat decompression for thyroid eye disease. The patient will have fat removed from the superior medial quadrant. A lid crease incision is made with the 15 blade. The needle tip cautery is used to dissect through the orbicularis muscle to the underlying orbital septum. The orbital septum is opened and the preaponeurotic fat is identified. The medial fat fad is identified and mobilized. This fat pad will be removed with the needle tip cautery. Malleable retractors are then used to bluntly dissect through the area of the medial fat pad, into the superior medial quadrant. The posterior component of the medial fat pad remains and will be removed to facilitate entry into the superior medial intraconal space. Takahashi forceps are used to engage the fat. Gentle traction is placed on the fat and the fat is removed. When engaging this fat, you get tactile feedback and should be able to gage how much traction you can safely apply. Additional fat is removed. The malleable retractors are used to bluntly dissect to release the orbital septa and mobilize additional fat. The Takahashi forceps are then used to remove the fat. This is repeated. Fat is removed until the fat no longer prolapses forward. Then, the malleable retractors are again used to dissect through the septa and mobilize the fat. Once no additional fat can be mobilized, the lid crease incision can be closed. Inspecting the volume, approximately 1.5 cc of fat were removed, which will translate into 1-2 mm of proptosis reduction. Over 400 oculoplastic surgery videos are available, free of charge, here on YouTube and at www.oculosurg.com