Thyroid Eye Disease

Burroughs Complete Oculofacial Portfolio 9 15 16.docx 1Thyroid Eye Disease

Thyroid problems (shown is actor Marty Feldman) can affect the eye in many ways and goes by a variety of terms that include: thyroid associated orbitopathy, thyroid associated ophthalmopathy, Graves disease, Hashimoto’s disease, and others. Women are affected more then men, but men tend to have a more serious form of the disease. Approximately 90% of the time, patients with thyroid “eye disease” will be hyperthyroid (too much thyroid hormone) but 5-10% have hypothyroidism or euthyroidism (normal thyroid levels). Hyperthyroidism is characterized by nervousness, weight loss, hair changes, warm intolerance, sweating, and irritability. Ocular manifestations can include double vision, red eyes, problems with eye closure (lagophthalmos), bulging of the eyes (proptosis), retraction of the eyelids, vision problems, and eye/orbital pain.

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Most of the time, this autoimmune disease does not require surgical intervention. However, Dr. Burroughs is an expert orbital surgeon and performs surgery to remove some of the bone around the eye to make more room for the swollen and enlarged tissues in order to reduce their dangerous compressive effect on the eye and optic nerve. Rarely, emergent bony decompression surgery is required for orbital congestion that is causing vision loss. Dr. Burroughs prefers to perform “balanced” decompressions that have minimal incisions that heal well or nearly invisibly and which has less chance for causing worsened or new double vision issues. During a balanced decompression, the orbital volume is expanded by removing some bone between the eye and the ethmoid sinuses behind the nose and at the superior and lateral orbital bone between the eye and the brain and temple areas. Some thyroid eye disease patients have hypertrophy (too much) of orbital fat and benefit by fat removal and reconstructive eyelid surgery to allow the eyes to close better. Patients with orbital pain, eye exposure issues, and severe dryness vastly improve by reconstructive orbital and eyelid surgery. Shown is a patient with lower eyelid retraction that caused eye irritation and made her appear like she was always staring at people. She was very pleased following reconstruction by Dr. Burroughs.

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