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Author: Dr. Radmilo Roncevic

A significant number of patients with a diseased thyroid gland encounters large difficulties with the eyes. The eyes are bulging, ejected and eyelids are swollen and deformed. In addition to aesthetic problems various subjective symptoms follow (headache, pain or pressure in the eyes, increased tearing, duplicate images, gradual loss of vision, etc.). Conservative therapy, drugs and radiation, often provide little or no benefit. In such cases, a particular surgical procedure offers excellent functional and aesthetic results.

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Indications

A severe form of the disease when conservative treatment does not provide satisfactory results.

Contraindications

General body weakness and severe general diseases that do not allow larger operation.

Operation desciption

Surgery is performed through the lower and upper eyelid, so that no scars are visible after the procedure.  Access into the eye socket is provided through an incision in the eyelid; diseased adipose tissue of the eye  cavity is removed and the eye socket is expanded by removing part of the bone in the orbital walls. Extending the eye socket significantly reduces the pressure in the orbit, which is the culprit for all pathology. Reducing the pressure in the orbit causes recovery of extraocular muscles, optic nerve and the eyelids. Surgery is performed on both eyes in one procedure.

Results

Visible improvements can be appreciated right after the surgery (the eyes are significantly less bulging, eyelids less swollen and all symptoms are reduced). Definitive results are achieved in 2-3 months. During this time, the structures of the orbit and the eyelids recover and establish their normal function; the eyeballs return to their original position, and the swelling and subjective symptoms disappear.

Complications

After this surgery there are no recurrences, i.e. no deterioration or re-establishment of the disease is expected.  Complication rate is small to none in the hands of an experienced surgeon, while if a novice in this field performs the surgery many complications can ensue.

Recovery

Hospital stay after the surgery is around 3 days. Recovery lasts about 10 to 15 days. Reading and working on the computer is possible a month after surgery, with gradual increase in the time spent in these activities.

bulging eyes1
Fig. 1. Patient before operation, 3 months, 5 years and 15 years after operation
bulging eyes2
Fig. 2. Patient with malignant thyroid ophthalmopathy, before operation and only two weeks after operation

 

Updated: 2014-11-12

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