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
you