Thyroid Eye Disease - Orbital Reconstruction

Thyroid Eye Disease
	Options for Orbital Reconstruction
	Double Vision Surgery
	Eyelid Surgery
	Other Facial Rejuvenation Options

Options for Orbital Reconstruction

The eyeball (globe) sits in a bony space called the orbit (see below). The orbit contains fat, nerves and muscles that move the globe. During thyroid eye disease the muscles become larger and the fat is expanded causing the globe to bulge outwards (proptosis).

If proptosis is severe and/or accompanied by optic nerve compression, surgery may be necessary to restore the position of the globe in the orbit. Options include creation of windows in the bone (bone decompression) or removal of fat behind the eyeball (intraconal fat decompression). If decreased vision is due to the muscles compressing the optic nerve – compressive optic neuropathy - management options include oral or intravenous corticosteroids for temporary improvement. But definitive treatment is either external beam radiation (in non-diabetic patients without significant proptosis) or orbital decompression.

External Signs of Thyroid eye disease:

Exophthalmos (ex-ahf-thal-mos) also know as Proptosis (prop-toe-sis) means protrusion of the globe (eyeball). A Hertel's tool is used to measure the amount of proptosis.

Lagopthalmos (lag-ahf-thal-mos) means that the eyelid cannot completely close, leaving the surface of the globe exposed

Eyelid Retraction means that there is a space between the lid and edge of the iris.

Strabismus means that eyes are not aligned. Inflammation and enlargement of the eye muscles can pull/push the eye in different directions such that each eye sees a different image, and this can cause double vision.

Normal eye position	Eye protruding, eyelid retraction
Both eyes protruding	Measuring the amount the eye is pushed outward
Lagophthalmos eye not able to close

Orbital Decompression

Inflammation and swelling of the eye muscle and fat causes volume expansion. The eye is surrounded by bone on all sides except in the front, so the eye protrudes outward. An additional concern is that continued compression can eventually affect the optic nerve. In order to relive the compression - decompress -, an operation to remove parts of the surrounding bone is performed.

Incision	Bone removed
Bone removed	Lateral wall exposed
Bone drill to remove orbital lateral wall	Lower area worked on
Exposing nasal edge	Cutting medial bone
Bones removed	Eye now has room to move inward

Pre and Post-Op Orbital Surgery Instructions
Before & After Pictures of Thyroid Eye Surgical Procedures
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