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Thyroid Disease

Thyroid Related Eye Disease Treatments

Graves

Mild cases are treated with lubricant eye drops or non steroidal antiinflammatory drops. Severe cases threatening vision (Corneal exposure or Optic Nerve compression) are treated with steroids or orbital decompression. In all cases cessation of smoking is essential. Double vision can be corrected with prism glasses and surgery (the latter only when the process has been stable for a while).
Difficulty closing eyes can be treated with lubricant gel at night, or with tape on the eyes to enable full, deep sleep.
Orbital decompression can be performed to enable bulging eyes to retreat back into the head. Bone is removed from the skull behind the eyes, and space is made for the muscles and fatty tissue to fall back into the skull.
Eyelid surgery can be performed on upper and/or lower eyelids to reverse the effects of Graves on the eyelids. Eyelid muscles can become tight with Graves, making it impossible to close eyes all the way.
Eyelid surgery involves an incision along the natural crease of the eyelid, and a scraping away of the muscle that holds the eyelid open. This makes the muscle weaker, which allows the eyelid to extend over the eyeball more effectively. Eyelid surgery helps reduce or eliminate dry eye symptoms.

Exposure Keratopathy
Lower Eyelid Retraction
Optic Neuropathy
Strabismus

Upper Eyelid Retraction

Graves' ophthalmopathy generally causes the eyelids to open more widely.
The front surface of the eyeball becomes exposed beyond the eyelids and causes discomfort and excessive tearing; exposure keratopathy.
Surgically repositioning the eyelids can reduce the irritation.
If orbital decompression, eye muscle and eyelid surgery are required, the eyelid procedure is generally performed as the final procedure in the series.
The upper eyelid retraction may be worsened if the eye is unable to elevate normally (strabismus), and extra nerve impulses are sent simultaneously to the muscle which elevates the lid and to the muscle struggling to elevate the eye itself; once the restriction is treated (e.g. strabismus surgery), the degree of retraction often decreases.

Upper Eyelid Retraction

Lower Eyelid Retraction

Graves' ophthalmopathy generally causes the eyelids to open more widely.
The front surface of the eyeball becomes exposed beyond the eyelids and causes discomfort and excessive tearing.

In patients with thyroid ophthalmopathy, especially in the presence of relative malar hypoplasia, who don't want orbital expansions or orbital decompressions, the lower eyelid support is very helpful to both conceal exophthalmos and correct lid retraction. This woman underwent 11 procedures by plastic and oculoplastic surgeons prior to referral, including anterior and posterior lamella grafts to three of her eyelids. Upper eyelid retraction release and lower eyelid Medpor spacers achieved an acceptable result

Above Photos courtesy of Porex surgical, James Patrinely MD and Charles Soparkar, MD

Many different materials are available in order to help elevate the lower eyelids ranging from donated sclera to products like Alloderm, which elevates the eyelid from the inside.

Dry eye and foreign body sensation are major considerations for performing such surgery.

Exposure Keratopathy

In Graves' ophthalmopathy the eyeball protrudes beyond its protective orbit; this allows the front surface of the eye to dry out.
When the front surface of the eyeball becomes exposed beyond the eyelids and causes discomfort and excessive tearing; exposure keratopathy. (see Dry Eye)

Artificial lubricants such as tears and ointment, including:

Patients often benefit from the use of artificial tears and ointment at nighttime in order to moisten the cornea

Strabismus

Double vision usually occurs because the eyes are out of alignment.
Misalignment often is caused by one or more eye muscles that are too short or "tight" because of scar tissue from Graves' ophthalmopathy.
This scar tissue results from changes in the eye because of inflammation.

Prisms

Prisms may be temporary (pasted on) or permanently ground into your lenses. However, prisms do not work for all people with double vision. Sometimes eye muscle surgery is a more effective treatment.

Eye Muscle Surgery

The goal of eye muscle surgery is to achieve single vision when looking straight ahead and when reading. During eye muscle surgery the muscle is cut from its attachment to the eyeball and reattached further back. Usually eye muscle surgery does not require an overnight stay in the hospital. More than one operation is sometimes required.

Eye Muscle Surgery

Optic Neuropathy

If the optic nerve is compromised, and vision is threatened as a result of Graves' disease, the term optic neuropathy may be applied.

Orbital Decompression Surgery

Orbital Decompression Surgery

In orbital decompression surgery the bone between the orbit (eye socket) and the sinuses (air spaces next to the orbit) is removed.
A successful procedure improves vision and provides room for the eye to slip back into the orbit's protection.
There are possible complications of the surgery, however.
You may experience lip numbness for several months after the operation.
Double vision may persist or it may develop anew after surgery

View Orbits following 2 -wall orbital decompression

Orbital Decompression

The pictures below demonstrate the effects/outcome of decompression surgery surgery to correct exophthalmos and lid retraction.

Visit IOP Inc to learn more about lower eyelid spacer