To report a series of patients requesting treatment for temple-related problems following lateral wall rim-sparing orbital decompression for thyroid-associated orbitopathy and to discuss the surgical management.

A case series of 6 patients (5F:1M, n=11 orbits) with persistent, troublesome temple-related problems of at least 3 years duration that required further corrective surgery.

Median age was 57 years (range 23-65). Temple-related problems consist of bothersome temple hollowness (n=11), masticatory oscillopsia (n=8), temple tenderness (n=4) and a “clicking” sensation (n=4). Preoperative imaging studies showed the absence of deep lateral wall in all 11 orbits and evidence of prolapse of lacrimal gland into the wall defect in 4 orbits accounting for tenderness. Surgical approaches included the repair of lateral wall defect with MEDPOR implant, medial wall and intra-/extra-conal fat decompressions. Autologous fat transfer or dermal filler was used to improve temporal hollowness. Postoperatively, there was full resolution of symptoms of masticatory oscillation, temple tenderness, “clicking” sensation and a marked improvement in temple hollowness. Two patients developed new onset diplopia necessitating strabismus surgery.

Persistent, troublesome temple-related problems following lateral wall rim-sparing orbital decompression are rare but can be surgically corrected. Reconstructive surgery to repair the lateral wall defect and/or other approaches such as balanced medial wall and intra-/extra-conal fat decompressions may mitigate the issue.