Thyroid Eye Disease

Thyroid eye disease (a condition of Graves’ disease or hyperthyroidism) causes the eyes to bulge forward and the eye aperture (gap between two eyelids) to widen. This leads to double vision, severe inflammation, discomfort, dry or watery eyes, corneal abrasions, infections, and possibly loss of vision. The initial (active) phase of thyroid eye disease involves frequent swelling of tissues around the eyes, double vision, and even reduction in vision in severe cases. Active phase is treated with medications to reduce the swelling. Fortunately, the active phase of most thyroid eye disease patients ends in 18-24 months. However, the deformities (raised eyelid, prominent eyeball, or squint) may persist, and now requires surgery.


Prominent eyeballs due to thyroid eye disease. Cosmetic orbital decompression surgery performed through hidden incisions to reduce the prominence of the eyeball.



Prominent eyes due to inactive thyroid eye disease, corrected by orbital decompression surgery performed through hidden incisions



Prominent right eyeball due to thyroid eye disease, treated with two wall orbital decompression surgery



Correction of prominent eyes by orbital decompression surgery from the back of the eyelid, leaving no skin scars



Bilateral severely proptosed (prominent) eyeballs due to thyroid eye disease. It was treated with three wall orbital decompression via cosmetically hidden incisions.



Right eye severe proptosis treated with three wall decompression to match it to the other eye (eyelid and squint surgery is yet to be done).



Prominent right eyeball due to unsuspected thyroid eye disease. Treated with fat decompression surgery from the back of the lower eyelid.



Both eyes active thyroid eye disease treated with Pulse Steroid therapy



Both eyes severe thyroid eye disease causing lower eyelid inturning treated with decompression along with lower eyelid fat pearl grafting


Surgical Time and Recovery:
Decompression surgery is typically performed first in the staged surgical management of thyroid eye disease. It involves expanding the bones of the eye socket to allow the eye to fall back. It can be performed under local or general anaesthesia depending upon the severity.

Muscle surgery is performed next to alleviate double vision if present. Eyelid surgery is often the last stage of rehabilitation whereby the eyelids are lowered, yielding a more natural, aesthetically pleasing appearance and reducing the chance of future eye-related complications.
Discomfort is controlled with medications after surgery, and lasts for a week. Stitches are removed in 5-7 days. Most patients are back to light work within a week.

Note:
Multiple procedures are often required to bring the patient to a near normal appearance, and one has to wait for the active phase to pass away before surgery can be performed.

Insurance:
Health insurance will cover the costs of a reconstructive surgery for thyroid eye disease.

Other Procedures:
Other commonly performed reconstructive procedures include correction of Eyelid Lift (Blepharoplasty), Entropion, Ectropion, Eyelid Drooping, Eyelid and Skin cancer reconstruction, Facial Spasms, Facial Paralysis, Watering Eyes, Orbital Surgery, and Trauma and Maxillofacial Surgery