Midwest Eye Care Institute

Thyroid Eye Disease

The thyroid gland is located in the neck, and it produces hormones which are responsible for regulating one's metabolism. Patients that have over or under active thyroid disease or even euthyroid (normal) Graves' disease can develop associated eye and eyelid problems. 

The exact cause of Thyroid Eye Disease is unknown; however it is thought to be caused by thyroid hormones triggering an autoimmune response in the fat and muscles behind and around the eyes. One of the most common features of thyroid eye disease is a staring appearance to the eyes. Even when the systemic disease process is clinically stable, there can be edema (swelling), exophthalmos (protrusion of the eyes), upper or lower eyelid retraction, hypertrophied contracted eye muscles with secondary double vision, and in some instances excessive orbital fat which can bulge into the eyelids.

Common symptoms of thyroid eye disease include burning and excessive tearing of their eyes secondary to corneal irritation from protrusion of the eyes and retraction of the upper and lower eyelids, which makes the lids not cover the eyes as well. 

Eye drops, steroids, and time may provide relief for many, but symptomatic treatment is ineffective for approximately one-third of patients with thyroid eye disease.

In some cases, a series of surgical procedures around the eyelids and orbit is required to correct the stigmata of Graves’ eye disease. The usual order for the surgical correction of these problems is as follows:

1. Orbital Decompression
2. Eye Muscle Surgery
3. Eyelid Repositioning
4. Blepharoplasty

Usually, the eyelids can be adjusted so that re-operations are rarely necessary when eyelid levels are periodically checked during surgery, and the incidence of double vision after orbital decompression has been reduced using a balance technique, and appropriate pre-operative imaging to identify high risk patients.

The treatment of thyroid eye disease is complex, and patients should understand that often more than one procedure, and time between procedures, is required to achieve the desired result. Fortunately, with patience and appropriate therapy excellent outcomes can be achieved, and one will ultimately be rewarded for one's patience.