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Thyroid Eye Disease (Graves' Disease) - Orbital Decompression

Thyroid orbitopathy, also known as Thyroid Eye Disease or Graves’ Disease, is an autoimmune inflammatory condition, related to the thyroid gland, that affects the different structures within the orbit (eye socket) and surrounding tissues including the eye muscles, orbital fat, and eyelids.  The thyroid gland is also usually affected but the timing and severity of the thyroid gland disease and orbital disease can vary greatly.  A small percentage of patients may have eyelid and orbital manifestations of the disorder without developing a thyroid abnormality.

Symptoms of Graves Disease

As stated earlier, the eye/orbit involvement in Graves disease can range from very mild to very severe.  The symptoms usually begin slowly but they can develop rapidly. The usual course of the eye disease is worsening over a year period, with subsequent "burning out". It is during the "burned out" stage that rehabilitative surgery is usually performed.

Symptoms and signs also vary, depeding on the severity of the disease. These include eye irritation/dryness, eye pressure, tearing, redness, eyelid swelling, eyelid retraction, bulgy eyes (proptosis), double vision (diplopia) and blurred or even loss of vision.  The vision loss can be significant eye dryness or exposure (secondary to bulgy eyes - proptosis) and/or from optic nerve compression.


Evaluation and Surgical Management of Graves Disease (orbital decompression, eyelid surgery)

The treatment of a patient with Graves disease is multidisciplinary, with help of endocrinologist, thyroid surgeon, ophthalmologist, and oculoplastic surgeon.  The underlying problem, which is the thyroid gland, needs to be treated, which may include medications, radioactive iodine, and/or thyroid surgery.  During the active inflammatory stage of the thyroid eye disesase, the eye symptoms are treated conservatively, including aggressive eye lubrication and possibly systemic medication (steroids).  Smoking has been shown to worsen the eye pathology and hence quitting is highly recommended.  Frequent monitering may be necessary, especially in severe cases with significant bulgy eyes and risk of optic nerve damage.

Surgical Treatment for Graves Disease

Once the inflammatory phase of the disease has subsided, patients with eyelid abnormalities, double-vision or proptosis may be eligible for surgical correction to improve their function and appearance. The first stage of therapy is usually orbital decompression to reduce proptosis (protruded bulgy eyes) by expanding the eye socket (orbit) to allow the eye to move back. Dr Taban uses the latest minimally invasive technique, through hidden incisions, to achieve the desired effect. This is an outpatient surgery with about 7-10 days of postoperative swelling/bruising. Second stage surgery is for those with restrictive strabismus causing diplopia (double vision) not corrected by prism glasses. The third stage operation is eyelid surgery, both reconstructive (eyelid retraction surgery) and cosmetic (blepharoplasty). Eyelid retraction is a frequent abnormality of thyroid eye disease causing elevation of the upper eyelids, giving a “stared” look appearance. This can be corrected.

Tabanmd Graves disease diagram

Who Should Perform Orbital Decompression and Eyelid Surgery?

An oculoplastic surgeon, who is a member of American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS), is someone who is  a board certified ophthalmologist who has completed additional 2-year fellowship training in cosmetic and reconstructive plastic surgery of the eyelids, orbits (eye socket), lacrimal system( tearing system) and surrounding structures.  Dr. Taban is double board certified by American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS), American Academy of Ophthalmology (AAO), and a diplomat of the American Board of Cosmetic Surgery (ABCS).  Dr. Taban is an oculoplastic surgeon in Beverly Hills and Santa Barbara with expertise in minimal invasive techniques in orbital decompression and eyelid surgery.

If you are experiencing the symptoms of Graves disease, schedule a consultation with Dr. Taban to learn more about your treatment options. Dr. Taban is a board certified ocular-plastic surgeon in Beverly Hills and Santa Barbara.

Next, learn more about Orbital Tumors and Infection.