Thyroid Eye Disease – Repair of Lid Retraction

Grave’s disease (thyroid eye disease) can be a very difficult medical and surgical problem to treat.  The first consideration in Grave’s disease treatment is to make sure that the disease is stable (inactive).  Operating during unstable or active Grave’s disease can cause the inflammation associated with the disease to get worse, thus making the problems worse.

The other important consideration is disease severity.  Patients can lose vision from Grave’s disease, either subtly or explosively.  Occasionally CT scanning and visual field testing are indicated to make sure that this is not happening.

Once the disease is stable, there may or may not be a need for eye socket surgery, often with bone or fat removal, to allow more space for the eye socket contents.  However, the single most common problem repaired in patients with Grave’s disease is eyelid retraction.  The muscles of the upper and lower lids become scarred, and they can shrink back, leading to problems with eyelid closure or making people have the Grave’s disease “stare”.

Below is the preoperative photo of a patient with stable Grave’s disease.

This patient was not in danger of losing vision, which is not always the case, but she did have severe lid retraction.  After we demonstrated a period of stability and did special testing to confirm that she in fact was not about to experience vision loss, the decision was made to perform an eye socket decompression.  Bone was removed from the sides of the eye socket, to allow more room for the eye to sink back.

After a suitable period of time, eyelid surgery was performed.  In this case, the lower lids were lifted by placed segments of ear cartilage into them.  The upper lids were lowered using collagen implants.

Below, the patient is seen one month after this surgery.  Notice the significant reduction in the amount of the white of the eye that is visible.