Involvement of the orbit in thyroid disease can precede the onset of the disease in the gland, or appear several years after the initial disease. Usually both eyes will be involved, although not symmetrically. There are cases in which there is no connection between thyroid hormone balance and the onset of the disease in the eye socket. Common symptoms are a higher-than-normal position of the upper eyelid (eyelid retraction), redness of the eyelids, and bulging of the eye. In severe cases, the bulging of the eye can be so severe that corneal erosions appear (dryness and lack of complete closure of the eyelids). In even rarer cases, damage to the optic nerve may occur with decreased vision and visual field, as well as double vision if there is involvement of the extraocular muscles. Example of a computed tomography scan:
The cause of the disease is the infiltration of the orbital fat and eye muscles with inflammatory cells with exudate tissue edema. Fortunately, in many cases the orbital involvement is mild. The orbital disease is active for 6 to 12 months and then stabilizes, at which point corrective and reconstructive surgeries can be performed on the orbital and eyelids. In many cases, multiple surgeries are needed to restore the appearance of the eye and eyelids to the condition before the thyroid disease.
In cases of significant eye protrusion, and/or nerve involvement with decreased vision, orbital decompression surgery is performed. In this surgery, part of the bones in the orbital wall are removed and space is given for the fat and muscles to expand in such a way that the intraorbital pressure decreases. Sometimes, intraorbital fat can also be removed. We take an approach of removing bone from the deep lateral wall and medial wall in order to reduce the risk of developing double vision after surgery.
The cause of the disease is the infiltration of the orbital fat and eye muscles with inflammatory cells with exudate tissue edema. Fortunately, in many cases the orbital involvement is mild. The orbital disease is active for 6 to 12 months and then stabilizes, at which point corrective and reconstructive surgeries can be performed on the orbital and eyelids. In many cases, multiple surgeries are needed to restore the appearance of the eye and eyelids to the condition before the thyroid disease.
In cases where there is involvement of the extraocular muscles with double vision that is not corrected by prism glasses, surgery can be performed to release the involved muscles. These surgeries will usually be performed by a strabismus surgeon (an ophthalmologist specializing in pediatric ophthalmology and strabismus).
When there is retraction of the upper eyelid, eyelid recession surgery is performed. This surgery can be performed through a skin incision and/or a conjunctival incision depending on the severity. In severe cases, additional materials must be used to lower the eyelid to the desired level. Since thyroid disease has an abnormal increase in fatty tissue, patients will benefit from cosmetic surgery on the upper and lower eyelids (see description of surgery above).
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