About 40 to 60 percent of people who suffer from an overactive thyroid condition known as Graves’ disease will develop an endocrine ophthalmopathy – commonly referred to as protruding or bulging eyes. This is caused by an autoimmune disease, but the exact origins are as yet unknown. Due to increased fatty tissue in the eye socket and thickening of the ocular muscles, the eyeball is pushed forward, creating the effect of a bulging eye. The condition is often accompanied by severe headaches, a pressure sensation behind the eyes, light sensitivity, conjunctivitis and double vision. Apart from these unpleasant side effects, patients affected by this condition frequently suffer severe psychological problems as a result of the obvious facial disfigurement.
Medication or radiotherapy
Initial treatment focuses on correcting the overactive thyroid. This can be achieved by medication (radio-iodine therapy) or surgery (thyroid reduction). If the eye disease persists despite treatment of the thyroid problem, high doses of corticosteroids (cortisone) have proven to be effective. However, this form of treatment only works within the first year of developing the disease.
As a further form of treatment, external radiation therapy may be applied to the eye socket. However, the results of this treatment do vary a great deal and this option is also only effective in the early stages of the disease. If treatment with medication does not prove as successful as anticipated, surgery may well be recommended.
The specialists at the Centre for Plastic Surgery recommend transpalpebral orbital decompression, which involves removal of excess fatty tissue from the eye socket. This is achieved by making fine incisions on the upper and lower lid and has the effect of reducing pressure on the eyeball. Frequently an upper lid and lower lid correction to reduce the enlarged eye opening will be performed shortly afterwards.
Transconjunctival orbital decompression and the subsequent lid correction procedure carry a low risk of complication and are therefore suitable both for advanced cases of the disease, and instances where surgical intervention is desired for purely cosmetic reasons.
In more than 90 percent of cases this form of surgical intervention produces a lasting result. However, if the autoimmune disease flares up again and the problem recurs, a second operation – in this case bony orbital decompression (BOD) – may be considered in certain circumstances.
This alternative operation, bony orbital decompression, involves decompressing the eye socket by repositioning the socket walls. Due to the relatively demanding nature and high risk of this operation, it is only considered if the eyesight is at risk or there are severe medical problems associated with the eyeball.
Facts and figures
2 to 3 hours, under general anaesthetic
Length of stay at the clinic
Eye drops and sunglasses for 4 to 6 weeks, ophthalmological examination, physical rest for 3 to 4 weeks
Back to school or work
Resume after 6 to 8 weeks
Ready to socialise
Cost coverage must be requested from your health insurance company