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Dr. Harris: Thyroid eye disease or Graves' eye disease is an autoimmune problem where the antibodies attack the thyroid or causing it to release excess of amounts of thyroid hormone. The same antibodies attack the muscles that move the eyes and the fat in the eye sockets. The eye muscles become enlarged pulling the eyelids up and pushing the eyes forward. The eye sockets can become inflamed and the eyelids swollen. The most common symptoms of thyroid eye disease are dry eyes and tearing due to exposure of the corneas. Patients often have trouble completely closing their eyes. More advanced disease can cause double vision and even loss of vision as the optic nerves get compressed or the corneas are severely exposed. Thyroid eye disease has no cure and treatment involves controlling the symptoms until it runs its course. In most patients, the disease burns out in 18 to 24 months. Mild cases are treated with artificial tears and other treatments for dry eye.
When inflammation is severe, short courses of steroids or other immune altering medicines are used. Sometimes, even radiation treatment is employed. If a patient smokes, they are advised to stop as smoking can greatly worsen the disease. Once the disease has leveled off and there are no changes in the eyes for several months, surgery can be considered. Orbital decompression surgery is used to create more space in the eye sockets, which allows the eyes to move back to a normal position. It's also used in patients with optic nerve compression if they are losing vision. If a patient has developed double vision, eye muscle surgery can be used to re-align the eyes. Lastly, eyelid surgery can be performed to return the eyelids to a normal position and remove excess eyelid fat. Thyroid eye disease can be challenging to treat, but following with an experienced orbital surgeon can help you achieve the best long-term outcome.