How do I treat my eyes and eyelids affected by thyroid eye disease?

Thyroid eye disease also known as Graves’ disease or thyroid related immune orbitopathy are commonly referred to with the acronyms TED or TRIO can significantly affect the appearance of the eyes and eyelids I often see that people affected by this condition who are eager and highly motivated to improve their appearance with surgery as soon as possible it’s important to understand how this disease progresses and how the disease is managed in order to determine the optimal time to perform surgical procedures when indicated

I’m Dr. Amiya Prasad I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon I’ve been in practice in Manhattan and Long Island for over 20 years I’ve helped many people throughout my career with thyroid eye disease improve their appearance through different specialized procedures specific to the unique issues associated with thyroid related immune orbitopathy

Thyroid eye disease occurs when antibodies in your blood affect the thyroid as well as the tissues around the eyes for example inflammation from thyroid eye disease can affect the muscles and fat behind the eyes causing the eyes to bulge and protrude forward the upper and lower eyelids can also retract with or without the eyes bulging forward creating a staring type of appearance in terms of surgical correction it’s important to determine whether the thyroid eye disease is in an active inflammatory stage or a stable fibrotic stage the inflammatory stage is typically a time when the eye appearance is changing and the thyroid hormone levels are being managed by an endocrinologist medical management of the inflammation as well as the thyroid hormone can include interventions such as radioactive iodine steroid radiation therapy as well as medications to supplement or reduce thyroid hormone levels

This inflammatory stage can last two to five years surgery is usually not performed at this time unless there is a situation when vision is being compromised after the inflammatory stage is the fibrotic stage this period is characterized by the appearance of the eyes being more stable I confirm this by taking measurements of the relative prominence of the eyes using an instrument called an accelerometer as well as when appropriate slit-lamp examinations and of course taking clinical photos I routinely perform procedures to address the retraction of the eyelids as well as the changes in the skin and fat volume around the eyes there are times when thyroid eye disease can cause ptosis as well as laxity of the support structures such as the lateral canthal tendon for example I treat lower eyelid retraction with specialized procedures to raise the vertical height of the lower eyelid using a graft such as decellularized dermis

In addition I’ll perform a repositioning or reinforcement of the lateral canthal tendon using different methods of canthopexy or canthoplasty depending on the individual situation upper eyelid retraction can be addressed using procedures such as a removal of a muscle called Mueller’s muscle referred to as Muellerectomy I also perform procedures on the levator muscle the muscle which lifts or opens the eyes to allow the eyelid to move downward and use a graft material such as temporarily muscle fascia excess skin and fat can be addressed by more traditional cosmetic procedures such as upper and lower eyelid blepharoplasty however the relative prominence of the eyes and the inflammation that occurred does require in my opinion the unique skills and experience of an oculoplastic surgeon I regularly performed these eyelid restoration procedures under local anesthesia with LITE IV sedation so general anesthesia is avoided and my patients are comfortable and are able to return to work often in one week

I perform these procedures in my in office surgical facilities I do caution my patients with thyroid eye disease that there are some situations where the results may be challenging to achieve and secondary procedures may be necessary I’ve seen how tyroid eye disease can have a significant impact on a person’s facial appearance after the inflammatory stage has transpired and the eyes are stable in the fibrotic stage I work with my patient on a treatment strategy that best addresses their appearance with minimal risk I helped many of my patients restore their confidence and feel great about how they look after I performed their surgery

I hope you found this information helpful thank you for your question