Thyroid Eye Disease

Patients that have over or under active thyroid disease or even euthyroid (normal) Graves' disease can develop associated eye and eyelid problems.  This is believed to be caused by thyroid hormones triggering an autoimmune response in the fat and muscles behind and around the eyes.  Even when the systemic disease process is clinically stable, there can be edema (swelling), exophthalmos (protrusion of the eyes), upper or lower eyelid retraction, hypertrophied contracted eye muscles with secondary double vision, and in some instances excessive orbital fat which can hemiate into the eyelids.

Patients commonly complain of burning and excessive tearing of their eyes secondary to corneal irritation from protrusion of the eyes and retraction of the upper and lower eyelids, which makes the lids not cover the eye as well.  There is commonly a stare appearance as well.

Eye drops, steroids, and time may provide relief for many, but symptomatic treatment is ineffective for approximately one-third of patients with thyroid eye disease.

A series of precisely-timed, delicate surgical procedures may eliminate corneal irritation and provide the new look necessary to resume a more normal life.

Innovative surgical techniques have eliminated many of the former risks associated with reconstructive eye surgery.  These include:

• Orbital Decompression in which the bones around the eye are removed (Photo A)
• Lowering of upper eyelid (Photo B)
• Connecting outer corner of eyelids together (Photo C)
• Raising of lower eyelid (Photo D)
• Botox or removal of frown lines (Photo D)
• Removing fat from eyelids (Photo E)
• Straightening of eyes to reduce double vision (Photo F)

The technique to lower the upper eyelid by selective removal of eyelid muscles was developed by Dr. Putterman.  He was also the first doctor to recognize that frown lines are associated with thyroid eye disease.

Revisions are rarely necessary when eyelid levels are periodically checked during surgery, and the incidence of diplopia after orbital decompression has been reduced by a preoperative CT scan to screen out individuals at high risk.

Cheek tingling or numbness from the infra-orbital nerve that sometimes occurs after orbital decompression usually dissipates with time and needs no further treatment.

Patients with thyroid eye disease should understand that treatment will require multiple procedures and waiting periods.  This experience can be frustrating for patients, as it is natural to want rapid relief from both the symptoms and embarrassment.  Patients should remember that an excellent outcome is the reward for their patience.

Before and After Photos

Photo A: Orbital Decompression in which the bones around the eye are removed (Before Above :: After Below)		Photo B: Lowering of upper eyelid (Before Above :: After Below)		Photo C: Connecting outer corner of eyelids together (Before Above :: After Below)

Photo D: Botox or removal of frown lines and Raising of lower eyelid (Before Above :: After Below)		Photo E: Removing fat from eyelids (Before Above :: After Below)		Photo F: Straightening of eyes to reduce double vision (Before Above :: After Below)

Click any photo above to enlarge