One of the most common thyroid diseases is hyperthyroidism, or Graves' Disease, which is an autoimmune disease in which there is an overproduction of thyroid hormones. People with Graves' may experience some degree of difficulty with the eyes. Eye problems are most commonly caused by abnormal swelling of the soft tissues surrounding the eyes, and the enlargement of the muscles that move the eyes and open the eyelids. As a result, the eyes may protrude forward. There may be retraction of the upper eyelids, which forces the lids apart and results in an inability to fully close the eyelids. These symptoms result in wide prominent eyes, a fixed staring expression, and infrequent blinking of the eyelids. Double vision may also develop as a result of the swollen muscles.

Some patients start experiencing eye problems as soon as their thyroid becomes hyperactive. In other cases, though, the eye changes develop slowly, sometimes not occurring until months or years after the beginning of abnormal thyroid activity. There may be pressure around the eyes, double vision, excessive tearing, and irritation of the conjunctiva (the mucous membrane that lines the eyelids). In the early course of the thyroid disease, only one eye may be affected. But as the disorder progresses both eyes usually become involved. Overexposure of the eyes during the day and an inability to completely close the eyelids at night can result in injury or damage to the cornea (the front of the eye). Dryness of the cornea can cause considerable discomfort and visual problems, such as blurred vision, foreign body sensation, or light sensitivity. As the muscles slowly enlarge, movement of the eyes may become restricted. This restriction in movement may cause misalignment of the two eyes, resulting in disabling double vision.

If the swelling is severe, the pressure in the orbit can become extremely high. This can cause compression of the optic nerve. If this happens, the person may experience a slow loss of vision and even blindness if the condition is not corrected.

Medical treatment of the hyperactive thyroid gland may sometimes relieve the associated eye problems, but often it does not. In cases of mild eye problems, treatment is directed at minimizing the symptoms. Sleeping with the head elevated and using diuretics can reduce swelling. Topical ointments and artificial tears may soothe the eyes. The use of plastic shields at night can help prevent drying of the cornea if the eyelids cannot close during sleep. Tinted glasses with side guards will help protect the eyes.

In more severe cases, surgery may be needed to correct the condition. The function and appearance of the eyes can usually be improved by reconstructive eyelid and/or orbital surgery. The particular surgical technique used will depend on the type and severity of the eye problems. Removal of excessive orbital fat in the eyelids can improve the patient's appearance. Eyelid surgery, to adjust the position of the eyelids, can help minimize retraction of the lids. Eye muscle surgery, in which the enlarged muscles that control eye movement are repositioned, may be performed to properly align the eyes and correct the double vision. Orbital decompression (removal of part of the bony orbit to relieve pressure within the eye socket) can prevent damage to the optic nerve. It also allows the eyes to move back into a more normal position within the sockets.

Continue reading for details on particular surgical treatment options.

When it comes to Thyroid Eye Disease, there are several different treatment methods that are going to vary largely based on your particular symptoms and individual needs. The following procedures listed are just a few of the primary treatments provided through this office, all of which may be done alone, or in succession.

Sometimes, in order to relieve compression on the optic nerve or to correct substantial bulging of the eyes, removing part of the bony orbit and fat behind the eye is necessary.

• In an orbital decompression the surgeon will create fractures in the bony walls of the orbit that will allow the eye(s) to fall back further into the orbit creating a more natural appearance. This surgery does present possible risks including, but not limited to, numbness around the eye, face, teeth, and lips, and possible development or worsening of double vision.

• In an orbital fat decompression the orbital fat that has expanded in volume is reduced or removed through surgery. By reducing the soft orbital tissue surrounding the eye, the eye should then be able to sit comfortably back in the natural orbit. This procedure will help relieve pressure and create a more natural appearance. A limited amount of tissue can be taken which is why this procedure may be done alone or in combination with a bony orbital decompression depending on the severity of the symptoms.

When the eyes become swollen and protrude, the muscles that control the movement of the eye may become constricted. Subtle movement becomes difficult and the eyes may not align properly which could lead to double vision. This condition is called strabismus. If the problem cannot be corrected through specialized lenses then eye muscle surgery may be necessary. In Thyroid Eye Disease the eye muscles may become stiff and the eyes deviated in or down. To correct this problem one of the six muscles connected to the eye will be detached from the eye and reattached further back on the eye. This will weaken the muscle and allow the eyes to assume a normal position.

When the active inflammation has subsided and the disease has become stable, protrusion of the eyes may diminish slightly but still be present. The lids often retract back and have difficulty blinking or closing. This is part of what causes the look of "surprise" or "staring". If slight enough, an upper and/or lower eyelid retraction repair may be possible to correct the condition.

• Eyelid retraction repair is an outpatient procedure usually done under local anesthesia. An incision is made along the eyelid(s) and the muscle that controls elevation of the eyelid is loosened and repositioned. This will allow the lid to function better and close properly, thereby protecting the cornea.

• Sometimes a graft is necessary if more tissue is needed to help stabilize the lower eyelid(s) new position. Often this is taken from the roof of the mouth as it allows for more moisture because of the mucous membrane. Sometimes Alloderm, or donated human tissue may be employed instead. In both of these cases, the tissue will be sewn into the inner lining of the eyelid(s). No visible scar will show and the stitches will need to be removed based on your surgeon's recommendation (usually 5-7 days).

For After Surgery Care guidelines for Thyroid Eye Disease Treatments, click here.