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. Graves’ ophthalmopathy affects the orbit around the eye, characterized by upper eyelid retraction, lid lag, swelling, redness, conjunctivitis and bulging eyes. Ophthalmopathy occurs in 50% of Graves’ cases with severe forms affecting 3-5% percent of these patients. Graves’ ophthalmopathy is more frequent in women than men (1:4 male-to-female ratio). Rates of this condition peak from ages 50-70.

Graves’ disease and Graves’ ophthalmopathy are chronic diseases with both physical and psychological symptoms ranging from no manifestations to severe manifestations.

What are the symptoms of Graves’ ophthalmopathy?

Graves’ Ophthalmopathy (Eye Disease)
This eye condition is caused by an abnormal increase of fat tissue within the orbital cavity, as well as overdevelopment of the eye muscles. Since the eye socket or orbit is hard, inflexible, and cannot accommodate the larger eyeball, the eye bulges out. In addition to bulging eyes, other symptoms may include headaches, pressure sensation and tearing (see below for additional symptoms). In extreme cases, the pressure can cause optic neuropathy leading to a loss of vision.

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?

Graves' Disease TreatmentDuring its early, active stage, Graves’ ophthalmopathy can be treated with non-surgical therapies, such as corticosteroids. Patients who do not respond to steroids or other conservative measures may benefit from surgical intervention. Dr. Tushar Patel at The Institute for Advanced Reconstruction offers a unique surgical solution for Graves’ ophthalmopathy with excellent results.

What is orbital decompression surgery?

Dr. Patel is an expert in transpalpebral orbital decompression, a technique first described by Dr. Neven Olivari of Germany in 1988. 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 procedure can improve 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.

What is recovery like?

Typically, surgery is performed on one eye at a time with two weeks to a month of recovery in between. Oftentimes, the surgery can be performed in an outpatient setting. Patients may experience swelling and bruising, but the majority is gone within a week. Post-operative pain is mild. The entire recovery takes about four weeks.

How successful is orbital decompression surgery?

The success rate of decompression surgery depends on the severity of the ophthalmopathy. However, the large majority of patients obtain a high level of success with decompression surgery. The majority of our patients treated with transpalpebral orbital decompression have experienced 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.

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% and the improvements in most patients are modest. Even after successful immunosuppression, most patients have remaining eye changes and still require rehabilitative surgery.

Surgical intervention may be 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 their diagnosis and determine if they are a candidate for orbital decompression surgery.



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