Graves Disease, Can Surgery Fix my Eyes?

Graves' disease can make the eyes bulge (proptosis),  and it can also make the eyes open too widely (eyelid retraction). In some cases Graves' disease can disturb the muscles which move the eyes (restrictive strabismus)  and cause double vision.  In a small percentage of cases the sight can be damaged by compression of the optic nerve.

The good news is that specialists who frequently treat patients with thyroid eye disease can really do a lot to help.  The surgeries for this condition have come a long way in the last 15 years.

An oculoplastic surgeon who is a member of the ASOPRS should be well qualified to evaluate and help you through this tough condition.  The attached ITEDS web site  (thyroideyedisease.org)  has useful information.  Aso check out NGDF.org

Best wishes,

Mark Lucarelli, MD,  FACS

Madison, WI

Graves disease can affect the eyes, with proptosis (buldy eyes) and eyelid retraction, among others.  Surgery is usually delayed until the eye/orbit component of the disease has been stable for a few months.  The first stage surgery is orbital decompression, followed by muscle surgery (if necessary), followed by eyelid surgery.  Consult an oculoplastic surgeon.

Yes, you ultimately should be able to have correction for the sequelae of thyroid eye disease. The key is to wait until the disease is stable and active inflammation has subsided. In the interim, you should be examined by an oculoplastic surgeon to watch for any signs of vision change, double vision or dry eye.

Dear Vickstar,

There is surgery available to reconstruct your eyelids.  The main question is when is the best time.  Consult an Oculoplastic surgeon for the best advice.

I agree you have the classic stare of Graves' Disease.  The management of this condition with the eyes is very complex, and has to be individualized for each patient.  Particular attention needs to be paid to where you are in the course of the disease process, as it typically ends after 1-2 years.  During that time you are "active" with inflammation and discomfort.  There is progression of the manifestations, including lid retraction, proptosis (bulging of the eye), and double vision.  There can even be compression of the optic nerve that can lead to loss of vision.  There is a great variation in who gets these manifestations and to what degree.

After the "active" phase, the inflammation resolves, but some people are left with permanent changes.  Ideally this is the best time to do surgery.  I would recommend you speak with your endocrinologist, and get a referral for him/her to an Oculoplastic Surgeon.  The endocrine doctors will know who does a good job for their patients in your community.

Yoash Enzer, MD