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What is thyroid eye disease?
Thyroid Eye Disease (TED), also called thyroid associated ophthalmopathy (TAO) and Graves’ ophthalmopathy/orbitopathy (GO), is the most common orbital disease, affecting 25%-50% of patients with Graves’ Disease (GD) . Clinical symptoms and signs are usually mild, consisting of ocular irritation with redness and tearing, “stare” due to lid retraction and exophthalmos, and periorbital swelling.
What are the treatments for thyroid eye disease?
There are several treatments for ocular thyroid disease, the most common of which are the use of drops or gels that relieve dry eyes, the use of asteroids, which is one of the most common treatments that can relieve symptoms, and radiotherapy, which uses The radiation targets the area behind the eye and the surgery we describe.
When are thyroid eye surgeries performed?
Once Thyroid Eye Disease (TED) reaches the chronic phase, surgery is sometimes used to correct serious damage caused by scarring.
Surgery may help correct a number of TED symptoms, including bulging eyes, double vision, retracted eyelids, misaligned eyes and other changes to your appearance and vision. While some people with TED may achieve the desired results with the first surgery, multiple surgeries are usually needed—sometimes as many as 4 or more.
Who performs ocular thyroid surgery?
TED surgeries are often performed by an oculoplastic surgeon or strabismus surgeon. These surgeons are eye doctors who specialize in surgery of the eye.
What are the steps involved in thyroid surgery?
Because TED surgeries are complex, they usually take place in a very specific order.
Orbital Decompression Surgery
The goals of orbital decompression surgery:
Improve the eyelid’s ability to close over the eye, which means that the eye will be better protected
Reduce the appearance of eye bulging
Relieve eye pain
Release pressure on the optic nerve, which can restore and/or improve vision
Potentially improve double vision, but correcting double vision will often require a follow-up surgery called strabismus (strah-biz-muss) surgery
What are the steps involved?
The surgeon will remove, shave, or sculpt a section of bone from behind the eye to help the eye move back into its socket
The surgeon may also remove some fat from behind the eye, which can harden because of inflammation
Room is made behind the eye for the enlarged muscles that developed with the disease
This surgery can be done endoscopically, meaning a small cut is made above the eye or through the nose
Double Vision (Strabismus) Surgery
The goals of double vision surgery:
Correct double vision that may remain after orbital decompression surgery
Helps people with TED to have better straight-ahead vision needed for daily activities like driving or reading
This surgery may eliminate the need to wear prisms, which are corrective glasses that help with double vision
What are the steps involved?
During double vision surgery, the surgeon “manipulates” or moves the muscles around the eye to get the eyes to point in the same direction
In about 5-10% of cases, more than 1 surgery is needed to achieve good muscle placement
Eyelid repositioning surgery
The goals of eyelid repositioning surgery:
Return the eyelids to a more normal position
Restore appearance
Reduce dry eye
What are the steps involved?
During eyelid repositioning surgery, the surgeon releases the muscles and tendons around the eyelid, allowing the eyelids to return to a more natural position
A common phrase associated with this surgery is that the “eyelids are lengthened”
Face sculpting
The goal of face sculpting surgery:
Restore appearance of the eyes and face
What are the steps involved?
The swollen and puffy tissue around the eye can be treated with sculpting surgery such as blepharoplasty (blef-ah-roe-plas-tee), also called an eye lift, or facelift surgery
The aged appearance of the skin can be treated with laser resurfacing and injections
Doctors recommend that patients wait 2-4 months between each surgery. Depending on how many surgeries are required, the surgical process for TED can last anywhere between 2-16 months.
References
https://www.thyroideyes.com/thyroid-eye-disease-treatment/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2752271/
https://my.clevelandclinic.org/health/diseases/17558-thyroid-eye-disease
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