Eyelid Retraction Repair
In thyroid eye disease, or Graves’ disease, the eyelids can open too widely. Once the disease has remained stable for six months, corrective eyelid surgery can be performed to lower the eyelids back to their normal position. This is done both to improve appearance and to improve the health of the eyes, (the abnormally open eyelids cannot blink properly and leaving the eye inadequately lubricated and protected). This is performed as an outpatient, often with the CO2 laser in order to minimize bruising and speed healing.
Some patients with Graves’ disease require orbital decompression, either to protect the vision, improve comfort, or improve their appearance by letting the eyes go back into the orbit. Dr. Schiller is pleased to be able to offer state-of-the-art minimal incision orbital decompression with the incisions placed inside the eyelids. Recovery is remarkably fast with minimal bruising and a small or no external scar
Before and After Orbital Decompression Surgery.
Her bulging eyes have moved back into the orbit.
Double Vision Correction
Double vision is often the most disturbing result of thyroid eye disease, and surgical correction provides remarkable relief for these unhappy patients. Dr. Schiller performs adjustable muscle surgery under local anesthesia with intravenous sedation, which guarantees the patient’s comfort and safety, while allowing the eyes to be adjusted to achieve clear single vision after only one procedure in almost all cases.
Before and after one operation to recess four muscles.
Note the reflection in the center of the eye which shows how badly her eyes are misaligned.
The reflections are centered after the operation. Her double vision was cured in one procedure.
Scroll below to read Dr. Schiller’s patient information sheet on thyroid eye disease. Click here to see before and after photos of some of Dr. Schiller’s thyroid eye disease patients.?Click here for the International Thyroid Eye Disease Society.
Dr. Schiller’s information sheet for patients with Thyroid Eye Disease
Graves disease is an autoimmune disease. This means that the immune system that defends us from infections is attacking our own body. You may have heard of other diseases where the immune system attacks the patient’s own body. In rheumatoid arthritis, the white blood cells (immune system) attack the joints. In lupus, the lungs are attacked. In the commonest type of Graves disease the white blood cells attack the thyroid gland, releasing thyroid hormone. Testing the blood for the level of thyroid hormone confirms the diagnosis. This hormone affects many systems of the body.
In a small percentage of patients with Graves disease, the immune system also attacks the fat and muscles behind the eyes, causing
- inflammation of and around the eyes
- swelling of the upper and lower eyelids
- protruding (bulging) of the eyes
- pain around the eyes
- sometimes double vision
- rarely, loss of vision.
The inflammation usually lasts from six months to two years. The attack on the tissues behind the eye can happen before the thyroid is attacked, at the same time, or later. In most patients with Graves disease the immune system attacks only the thyroid and not the eyes. Graves eye disease is much more common in people who smoke or are around heavy smokers. In some patients the attack can be on the tissues behind the eye and not on the thyroid gland, so that the thyroid blood tests are negative. In that case the diagnosis is made by seeing enlarged muscles or fat behind the eyes on the CT scan (a special x-ray), and sometimes by a special blood test for chemicals (antibodies) attacking the thyroid.
When Graves disease affects the eyes, several problems can occur:
- The inflammation can result in redness of the eyes and pain and pressure around the eyes. If it is mild, this can be treated with medications like Advil (ibuprofen). In more severe cases, prednisone pills are used.
- The eyelids can open too widely, and this interferes with the way the eyelids blink and lubricate the eyes, resulting in dryness and irritation of the surface of the eys and discomfort. This is treated initially by using lubricating eye drops. After the diesase has stabilized, the eyelids can be placed back into their normal position by surgery.
- When the muscles are swollen they cannot move the eyes smoothly, and if the two eyes do not move together, then double vision can result. This can be treated by special prism glasses or surgery.
- If the swelling behind the eyes is severe, the eyes can be pushed forward in the socket (orbit). The pressure behind the eyes can damage the optic nerve, which carries the image from the eye to the brain, decreasing the vision. The first treatment is with prednisone pills., Some patiens require orbital decompression surgery, which opens the bones arouund the orbit to allow more room for the swollen muscles, relieves the pressure on the optic nerve, and allows the eye to move back into the orbit.
The eye symptoms of Graves disease can be quite distressing and can last for some time. Once the disease has stopped evolving, corrective surgery can generally improve the comfort, eliminate the double vision, and even improve the appearance of the eyes.