What is thyroid eye disease?

Woman with thyroid eye disease, big eyesThyroid eye disease (TED), also known as Graves’ disease or thyroid-related orbitopathy, is an autoimmune condition where the body mounts an immune response to the thyroid gland and the tissues in the eye socket (the orbit).

This can cause swelling and expansion of the muscles and the fat inside the eye socket, pushing the eyeball forward and making the eyelids retract.

The condition can cause muscles to not move properly, resulting in double vision and bulging eyes.

In the most severe cases, TED can cause enough pressure in the eye socket that the blood supply to the optic nerve is compromised, causing blindness.

Symptoms of thyroid eye disease

  • Bulging eyes
  • Inflammation
  • Blepharitis (dry eye)
  • Bloodshot eyes
  • Double vision
  • Eyelid retraction
  • Vision impairment or blindness

Nonsurgical treatment options

TED can often be treated with medication and lifestyle changes, including:

  • Quitting smoking is one of the most important steps, as smoking increases your chances of developing TED and worsens swelling and inflammation, prolonging the course of the disease
  • Using certain steroids
  • Receiving certain kinds of radiation therapy
  • Taking medications to block the immune system, such as tocilizumab (Actemra®) and teprotumumab (Tepezza®)
    *Tepezza® is currently the only medication approved by the FDA to treat TED.

But there are also surgical options.

Orbital decompression surgery for thyroid eye disease

You may require orbital decompression surgery to prevent vision loss or to reduce eye bulging. Orbital decompression involves removal of one or more of the bones (walls) of your eye socket, and sometimes, the fat inside your eye socket.

This creates more room inside the eye socket to allow the eye to sink back to a normal position and decrease the pressure.

This surgery is usually performed 18 to 24 months after the onset of TED, unless you’re experiencing vision loss, making the surgery more urgent.

How the surgery is performed

Surgery for orbital decompression is performed under general anesthesia. The location of the incision depends on which eye socket walls need to be removed. If there is asymmetry in the eyes, it may be recommended to have surgery on one eye to create a baseline. Surgery for the other eye will then be performed later to match the recovered eye.

There are different types of orbital decompression surgery depending on the severity of your condition:

  • Medial decompression is for patients with a low amount of bulging. It’s the least invasive, involving a small incision on the inside corner of the eye. Surgery lasts around 30 minutes and leaves no noticeable scar.
  • Lateral decompression is for patients with more bulging. Through an eyelid crease incision, dissolvable or removable stitches are used. This usually takes 1.5 hours.
  • Multiple wall removal may be needed for patients with significant bulging. Depending on the number of walls being removed, the surgery may be done on one side at a time, or on both sides on the same day. Surgery time will increase with each additional wall removal.

What to expect after your surgery

After surgery, your doctor may prescribe ointment or eyedrops. You won’t need to wear an eye patch or bandage. Keep the area clean to reduce risk of infection.

Recovery time depends on how many walls are removed. The average patient may take one to two weeks off from work before returning to full activities. It may be between six and 12 weeks before you feel fully recovered or can’t notice that you had the surgery. Stitches, if used, are removed one week after surgery.

Results of TED surgery

Results of surgery should be a settling of the eyeballs into the eye sockets, reduction of swelling and pressure, and improvement in eyelid closure and some vision issues. Only 5% of patients who receive orbital decompression surgery have the condition return.

Other surgical options

Other surgeries that can help patients with TED are eye muscle (strabismus) surgery to improve double vision, and eyelid surgery to improve eyelid closure.

The oculofacial surgeons at Ohio State have been trained to use the most advanced surgical techniques to achieve the best possible outcomes for you.

Will insurance cover this procedure?

Orbital decompression surgery is typically covered by health insurance. Make sure to consult your provider for details on coverage.

Why choose Ohio State Ophthalmology for thyroid eye disease care?

Traditionally, orbital decompression was accomplished by using a high-speed drill to remove bone from the eye socket. Here at The Ohio State University Wexner Medical Center, we utilize ultrasonic bone aspiration. This advanced technology is much gentler than traditional drills and poses less risk to the orbital soft tissues and tissues behind the eye socket.

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