Prominent Eyes, Scary Look!

Introduction

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.

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

Before-After  Photos

 

In Decompression Surgery, the bony socket (cone) is widened to allow the eyeball (ice-cream) to sink into normal position.

Both eyes  have undergone a Key-hole 3-wall orbital decompression procedure. Notice the reduction in the forward protrusion of the eyes.

Both eyes Key-hole 3-wall orbital decompression procedure, followed by correction of upper eyelid retraction.

Right eye is more prominent than the left. Both eyes underwent minimally invasive Key-hole orbital decompression procedure. Right eye 3-wall decompression, and left eye 2-wall decompression was performed.

Severe proptosis due to thyroid eye disease. Both eyes underwent Key-hole 3 wall orbital decompression, to restore the normal appearance.

Another case of moderate proptosis, treated with 2 wall orbital decompression. No visible scars anywhere on the skin.

Moderate proptosis due to thyroid eye disease, treated with 2 wall orbital decompression.

Severe proptosis of both eyes, managed by Key-hole 3-wall orbital decompression surgery.

Note the reduction in the puffiness around the eyes, and absence of any visible scars!

Both eyes severe proptosis, managed by Key-hole 3-wall orbital decompression surgery.

Note the reduction in the puffiness around the eyes, and absence of any visible scars!

Mild to moderate prominence of the eye, treated with scarless Fat decompression and Eyelid surgery.

Moderate prominence of the eyes, treated with Key-hole 1-wall orbital decompression procedure, and eyelid correction.

Sometimes, thyroid eye disease may affect only one eye. Corrective procedure is then required only in that eye.

Thyroid eye disease  affecting only left eye. First a decompression is performed, followed by eyelid surgery to achieve symmetry.

Thyroid eye disease  affecting only right eye. A decompression  surgery through a hidden incision achieves symmetry.