In thyroid orbitopathy, the tissues behind the eye swell, pushing the eye forward and out of its natural socket. The eyes appear to be bulging and the eyelids may not close completely. Patients may complain of dry, itchy or irritated eyes. The condition can also cause double or blurred vision, mild eye pain and sensitivity to light. In severe cases thyroid orbitopathy can lead to ulceration of the cornea or compression of the optic nerve.
For most patients, thyroid orbitopathy is mild and progresses slowly before gradually resolving on its own. Significant symptoms develop in 10 to 15 percent of patients. Women are four times more likely to develop the condition than men. Smokers appear to have a much greater risk for severe symptoms.
If symptoms of thyroid orbitopathy become severe, or patients are seriously concerned about the cosmetic appearance of their bulging eyes, some physicians will perform a surgical correction. Plastic Surgeon Allan Wulc, M.D., uses a procedure called orbital decompression. Instruments are passed through the nose to reach the eye socket from behind. A few sinus cavities are removed. Then, the bone behind the eye socket is removed. If necessary, a small incision is made into the bone on the outer side of the eye socket and the surrounding bone is thinned. Through other incisions, a small amount of fat from the upper and lower eyelids may be removed. The procedure enlarges the space behind the eyeball for the swollen muscles and tissues and reduces the appearance of the “bulging eyes.”
There are risks associated with orbital decompression. The procedure can lead to the development of double vision or vision loss. For that reason, Wulc prefers to do one side at a time. About three months after decompression surgery, the eyes can be straightened and eyelids adjusted.