Causes of bulging eyes                                                                                             Bulging eyes are most commonly caused by a thyroid disorder. Extra fat and muscle size behind the eyeball pushes it forward. In addition, the upper eyelid shoots up due to scarring, giving it a 'wider' look. Rarely, an eye bulge could be simply hereditary (acquired from one of your parents), or it could be a large eyeball (myopia).

What is Thyroid Eye Disease?                                                                                   Thyroid eye disease is an autoimmune disease where your body produces abnormal thyroid antibodies, and the eye can get involved. It is divided into 2 phases: Active and Inactive phase.                                                                                                                  a) The active phase: This lasts up to a year, starting from the onset of your eye problems. During this period, redness, swelling around the eyes, double vision, and prominence of the eye can increase. During the same period, the condition may naturally improve, in few cases. During this phase (first year), most cases are simply observed (do nothing) or steroids are given if vision is dropping.                                                                            b) The inactive phase: This starts approximately from the 13th month since the onset of the eye disease, for the rest of your life. It is during this phase that corrective surgeries are planned. The abnormalities that require surgery include proptosis (prominent eye), eyelid retraction (eyelid shooting up), and squint. All these components require different surgeries and are performed 2-4 months apart.

What happens during the active phase?                                                                    During your consultations in the first year, we measure the vision function, prominence of the eye (exophthalmometry) to see if its is improving or worsening. We also give steroids if required (all patients do not benefit from it). In addition, we may also need to perform a Computed tomography (CT scan) to know the anatomy around the eyeball. Unfortunately, despite normal blood levels, the eye disease takes its own course. Natural improvement is seen in < 5% cases, and most require surgical correction in the inactive phase.

Surgery for bulging eyes                                                                                                 The eye can appear bulging because it is pushed forwards, or because the upper and lower eyelids are stretched wide apart. Both these components require different surgeries and are performed 2-4 months apart. Surgical correction of bulging eyes is possible by moving the eye back into the socket (orbital decompression surgery). This is usually done by micro-surgical fine drilling of the bones around the eye socket so that the eyeball relaxes in. The amount of surgery (number of 'walls' to be decompressed) is tailored to the degree of bulging. The surgery is performed under general anesthesia and requires a 1-2 day hospital admission. On a given day, only one eye is operated, and the second eye can be done after 3-7 days. Final check-up (before you leave to your home city) is usually done 2 weeks from the date of second eye surgery. Additional eyelid surgery if required is usually performed after 2-4 months.

Preparation for your surgery                                                                                       During your consultation, we measure the prominence of the eye (exophthalmometry), which decides the severity of the problem (mild, moderate or severe). In addition, we also need to perform a Computed tomography (CT scan) to know the anatomy around the eyeball. Finally, a few blood tests are mandatory for anesthesia fitness. Accommodation and local logistics would have to be arranged by you.

Charges                                                                                                                                To give an exact estimate, we first need to measure your eye findings. The extent of surgery (and therefore its cost) is dependent on measurements. However, here is a rough range of pricing:

Orbital decompression: 60,000-200,000 INR per eye, (depending upon number of walls required).                                                                                                              Eyelid surgery (Levator recession) to be performed after 2-4 months if required: 40,000-80,000 INR per eye                                                                                           General anesthesia charges: 8000-10000 INR (If performed under GA)               Hospital room charges: 5000-12,000 INR per night based on the type of room.


Insurance                                                                                                                            Most insurance companies will cover the charges for thyroid eye disease related procedures as they affect vision.

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