Graves’ Disease

Graves’ Ophthalmopathy (Eye Disease)

What is Graves’ ophthalmopathy?

Graves’ ophthalmopathy, also known as Graves’ eye disease, represents the most frequent non-thyroidal manifestation of Graves’ disease and is characterized by bulging eyes. Ophthalmopathy occurs in 50 percent of Graves’ cases with severe forms affecting 3 to 5 percent. Graves’ ophthalmopathy is more frequent in women than in men with a 1:4 male-to-female ratio; it is more common among cigarette smokers. Graves’ disease and Graves’ ophthalmopathy are chronic diseases with both physical and psychological symptoms ranging from no manifestations to severe manifestations.

Why do the eyes bulge?

Graves’ Ophthalmopathy (Eye Disease)
The tissues and muscles behind the eyes become inflamed and swell. Since the eye socket is inflexible and cannot accommodate the larger eyeball, the eye bulges out. This eye condition is caused by an abnormal increase of fat tissue within the orbital cavity as well as overdevelopment of the eye muscles. The result is not just bulging eyes, but headaches, pressure sensation, and tearing. In extreme cases, the pressure can cause optic neuropathy leading to a loss of vision.
What are the symptoms of Graves’ ophthalmopathy?

Common symptoms:

  • Inflamed eyes
  • Itchy eyes (some call it gritty eyes)
  • Swelling of the eyelids and tissues around the eyes
  • Widening of the space between the eyelids
  • Photophobia (sensitivity to light)
  • Reddened eyes

Moderate-to-severe symptoms:

  • Changes in visual sharpness or color vision
  • Abnormal protrusion of the eyeball(s)
  • Eye pain
  • Severe swelling around the orbit
  • Severe restriction of ocular motion

Severe symptoms:

  • Corticosteroid dependency
  • Excessive or disfiguring protrusion of the eyeball(s)
  • Optic neuropathy
  • Orbital congestion
  • Severe dry eyes
  • Blindness
How do you treat Graves’ ophthalmopathy?

At its early, active stage, the disease can be treated with non-surgical therapies, such as corticosteroids. However, for those cases that do not respond to steroids or other conservative measures, The Institute for Advanced Reconstruction features a unique surgical solution with excellent results.

Am I a surgical candidate?

Once Graves’ ophthalmopathy becomes chronic, it is often resistant to conservative therapy. The response rate to nonsurgical treatments is about 65 percent and the results in most patients are modest. Even after successful immunosuppression, most patients have remaining eye changes and still require rehabilitative surgery. Surgical intervention is indicated:

  • in the event that conservative therapy fails
  • during inactive stages of the disease
  • as an emergency procedure in cases of acute optic nerve compression
  • in patients with mild to moderate aesthetic impairment

Patients presenting with Graves’ ophthalmopathy at The Institute for Advanced Reconstruction undergo a thorough evaluation to confirm the diagnosis. Advances in screening, including more sophisticated imaging (CT or MRI), now allow surgeons to evaluate Graves’ ophthalmopathy more accurately.

In its more advanced stages, orbital decompression surgery, such as that performed by Dr. Tushar Patel of The Institute for Advanced Reconstruction, becomes necessary to reverse the effects of this condition.

What is orbital decompression surgery?

Orbital decompression surgery involves removing excess fat from the orbital cavity as well as expanding the orbital wall to alleviate pressure and congestion in and around the eyes. This will correct issues such as orbital congestion, pain, eye bulging, and eyelid disfigurement. In extreme cases, optic nerve damage, corneal breach, and eye dislocation are prevented. With Dr. Patel’s expertise, surgery may involve fat removal alone or include removal of bone to expand the orbital vault. Surgery often involves a combination of these techniques, depending on the severity of the situation and the stage of the disease. One technique employed by Dr. Patel is transpalpebral orbital decompression.

Dr. Patel is an expert in transpalpebral orbital decompression: a technique pioneered by famed plastic surgeon Dr. Neven Olivari of Germany. Orbital decompression, using the Olivari technique, underlines the importance in the role of fatty tissue in the evolution of the disease. Dr. Olivari first described transpalpebral orbital decompression surgery with the removal of intraorbital fat in 1988. The Olivari technique has been tested in more than 3,000 operations. From 1984 to 2004, a consecutive series of 1,635 patients (3,210 eyes) with Graves’ ophthalmopathy underwent this operation at Dr. Olivari’s institution in Germany (where Dr. Patel trained).

In patients who are eligible for this procedure, this technique provides a more refined approach than previous surgical techniques that relied on bony decompression alone. In one documented testimony, Brazilian surgeons who have written on their experience with the Olivari technique have concluded that surgical removal of orbital fat provides consistent improvement in appearance with a low rate of complications.

How successful is orbital decompression surgery?

The long-term postoperative results of the 1,374 patients studied are excellent. The majority of patients treated with transpalpebral orbital decompression had significant changes in functional and aesthetic outcomes. The majority of patients were satisfied with their cosmetic results and almost every patient showed a significant improvement in quality of life after surgical treatment. No patient developed a loss of visual sharpness. The conclusion of the study proved transpalpebral orbital decompression to be reliable, effective, and safe with long-lasting results in visual function as well as in the patient’s personal wellbeing.

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