Thyroid Eye Disease

Thyroid eye disease, also known as Graves disease, can lead to bulging eyes. Once the disease is stable, surgery can be done to improve the function and aspect of the eyes.

What you should know about Thyroid Eye Disease

Hyperthyroidism is not the cause of thyroid eye disease. The cause is an autoimmune condition called Graves disease that affects both the eyes and the thyroid gland. Patients should stop smoking as soon as they are diagnosed with Graves disease, otherwise they have 10 times higher chance of severe complications.

Most patients start experiencing eye problems as soon as their thyroid gland becomes overactive. For some, the eye changes may develop before hyperthyroidism is detected. Others may not develop symptoms until months or years later. Both eyes are usually affected, but not necessarily to the same degree.

In mild cases, the common symptoms are pressure around the eyes, ocular irritation and tearing. In severe cases, the inflammation of the eye muscles may result in restricted eye movement causing double vision. If the muscles become too swollen, they can compress the optic nerve resulting in progressive loss of vision.

The disease usually becomes inactive after 6 months to a year. At that time the patient is left with bulging and dry eyes, double vision and retracted eyelids.


The treatment of thyroid eye disease depends on the stage of the disease.

In the acute, inflammatory phase, intravenous infusions of steroid medication can decrease the swelling and the risk of developing permanent changes around the eyes. This treatment is done once a week in ambulatory setting (no hospitalization needed) for 10 weeks. Most patients have a positive response and do not require further intervention. In a minority of cases (5-8%) the inflammation is severe enough to produce vision loss from compression on the optic nerve. If there is no improvement after 2 weeks of intravenous steroid treatment, orbital decompression surgery is necessary to save the patients vision.

In the inactive, stable phase and only in patients who have stopped smoking for at least 6 months, surgery can be performed to correct the protruding eyes and the retracted eyelids.

Lateral orbital wall decompression surgery is the procedure of choice in those patients that do not have double vision. It is the only technique that can reposition the eyes without producing double vision. The procedure is performed through an upper eyelid skin crease incision and involves removing the back part of the bony lateral wall of the eye socket allowing the eyeball to reposition itself. The same incision is usually used to remove the excess fat around the eyes and to correct the eyelid retraction.

In most cases this procedure is sufficient to regain the normal eye appearance. Sometimes a Blepharoplasty is performed 4 to 6 months later to achieve the best cosmetic result.

Orbital Decompression Surgery

Surgery is performed under general anesthesia and takes about an hour. The patient returns home a couple of hours later. Only one eye can be operated at a time. The second eye can be operated one week later.