Thyroid Eye Disease
Thyroid eye disease is a relatively common immunologically-mediated orbital problem in which the tissue behind the eyeballs becomes swollen, and the eyeballs and eyelids are affected. In severe cases, bulging of the eyes can occur which may lead to ocular pain or even blindness. Often, thyroid hormone levels which are measured with a blood test are independent of the degree of the thyroid eye disease that is present. In some cases, the blood test indicates a low thyroid blood level, a normal thyroid blood level, or a high thyroid hormone blood level. Thyroid orbitopathy is a clinical diagnosis and cannot be measured independently with any blood work.
The surgical treatment for thyroid eye disease is quite variable, and depends on the presenting symptoms. In mild cases, simple observation is the treatment of choice. In severe cases, a series of operations can be planned, including an orbital decompression, which moves the eyeballs into a more posterior and protected position. Eyelid margin repositioning can be performed to correct the eyelid retraction which is often seen with thyroid eye disease. In some cases, strabismus surgery is performed to help straighten crossed eyes which can occur both with the thyroid eye disease and following orbital decompression surgery.
The surgical rehabilitation of patients with thyroid eye disease is the area where an oculoplastic surgeon is essential. The relationship between the eyeballs, the orbits and the eyelids is a complicated three-dimensional physiologic unit which needs to work well together.