What is Graves’ disease and how does it impact eyes?
Graves’ Disease is a disorder in which abnormal chemicals produced primarily by the thyroid gland result in excessive growth of the fat and muscles around the eyeball. People with this disorder may experience bulging eyes (proptosis), a “stare” appearance from upper eyelids that are too high (retraction), double vision, and a sandy sensation to the eyes from severe dryness.
How is thyroid eye disease treated?
First, your endocrinologist must control the underlying thyroid disease with a regimen of medication, radiation, or surgery. The majority of eye changes from Graves’ disease can be improved with surgery, but unless the optic nerve is being compressed (which is very rare), patients should not undergo surgery until their exam and thyroid function are stable for 6-12 months. Operating too soon may even result in worse vision, appearance, and reactivation of the disease. Often the “waiting period” after diagnosis but before the disease is stable is a frustrating period for both patient and physician, and a number of non-surgical treatments can improve patient comfort during this period.
When severe proptosis is present, the first surgery that is done is orbital decompression, or partial removal of the bones of the eye socket. We routinely perform this as a multispecialty team, bringing together ophthalmic plastic surgeons who remove some of the bone through a small external incision and Ear, Nose and Throat (ENT) surgeons, who remove part of the bone endoscopically through the nose. If necessary, the New York Eye and Ear Infirmary of Mount Sinai’s (NYEE) strabismus surgeons then perform eye muscle surgery to restore single vision in patients who experience double vision. Finally, oculoplastic surgeons can perform eyelid surgery to lower the upper lids and raise the lower eyelids to further improve the facial appearance.