Thyroid eye disease, more technically named Graves ophthalmology or Graves orbitopathy, is an inflammatory disorder of the tissues within the orbit or eye socket (i.e., including the orbital soft tissues, eye muscles, eyelids, and conjunctiva). Patients with this disorder often have a thyroid abnormality that may manifest itself either before, during, or after eye symptoms begin.
Signs and Symptoms
Graves ophthalmopathy can have a wide variety of presentations and severity. The disease can begin suddenly and progress rapidly over days to weeks or can start slowly and progress gradually. The majority of patients have mild symptoms, mainly with retraction of the upper and lower eyelids and bulging of the eyes (proptosis). More moderate cases have increased inflammation with visible redness of the eyes, eyelid swelling, and varying degrees of double vision (diplopia). A small percentage of patients have severe inflammation that can result in compression of the optic nerve ad permanent vision loss.
In most cases, the inflammation worsens over the first 6 months to a few years before subsiding spontaneously. Changes caused by scarring of the eyelid and orbital tissues may persistent, resulting in persistent proptosis, eyelid retraction, and/or diplopia.
Evaluation and Management
Patients should be evaluated by an ophthalmologist to assess the extent and severity of the eye disease as well as an endocrinologist to manage any thyroid abnormalities. Smoking has been proven to worsen thyroid eye disease, and quitting is the most important thing patients can do to help improve their outcome. Patients with mild ophthalmopathy can often be evaluated periodically and managed to reduce ocular symptoms. Patients with moderate to severe disease may require intervention to reduce inflammation and preserve vision. Once the inflammatory phase has subsided, patients with eyelid abnormalities, double vision, or proptosis may benefit from surgical intervention to improve their function and appearance. Dr. Dal Canto is specialized in evaluating and monitoring disease progression and in medical and surgical management of eyelid and orbital abnormalities resulting from Graves ophthalmopathy.
Before and After Photographs
Left Orbital Decompression and Lower Eyelid Elevation
49 year old female with left eye proptosis (bulging) from Graves disease and left upper and lower eyelid retraction. She underwent left orbital decompression to reduce the proptosis followed by left lower eyelid surgery to improve the retraction. Ocular comfort was improved so much she decided not to proceed with left upper eyelid retraction repair. |
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