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
