Orbital decompression surgery is performed as part of a staged surgical treatment plan for the effects of Graves’ disease on the eyes.
Graves’ disease is an autoimmune process that causes inflammation and destruction of specific target organs throughout the body. The primary clinically-apparent target is the thyroid gland, but about 50% of patients with Graves’ disease also have orbital and eyelid effects. Rarely, this inflammation in the orbit can lead to sight-threatening complications.
More often, patients with Graves’ related eye disease suffer a significant decrease in their quality of life caused by bulging of the eyes (proptosis/exophthalmos), poor eyelid closure (lagophthalmos), severe dry eye, double vision (diplopia), and eyelid retraction. Fortunately, almost all patients with Graves’ disease run a typical course of worsening symptoms, followed by a gradual improvement to steady state. However, most patients do not return to their pre-disease state.
The treatment of Graves’ disease requires a multidisciplinary approach. Since the thyroid is also affected, most patients are primarily followed by an Endocrinologist. This doctor will work to control the thyroid abnormalities and direct treatment of the thyroid inflammation as necessary. Unfortunately, treatment of the thyroid does not improve the eye symptoms, since Graves’ is a systemic problem. There is currently no consensus on a proven medical treatment that would address the body as a whole, but vigorous research is actively taking place on this topic. Because there is no medical treatment and because treating the thyroid does not cure the eye problems, Ophthalmologists and Oculoplastic Surgeons are usually consulted to care for patients with Graves’ related orbitopathy.
Treatment of the eye related problems in Graves disease is staged and begins with orbital decompression. In patients with significant proptosis and pressure sensation, the bones and fat of the orbit can be gently sculpted to make more space for the inflammed tissues. Not all patients require this step, but when indicated, it should be done prior to other eye surgery.
The second stage involves re-alignement of the extraocular muscles, which is done to address the double vision frequently associated with Graves’ related eye-disease.
Finally, the eyelid position can be fine-tuned by raising the lower lid or lowering the upper lid to address the lid retraction and poor lid closure.
If you have been diagnosed with Graves’ disease or hyperthyroidism, and want to know if your eyes are being affected, please call our office to schedule an appointment for a complete orbital evaluation.
