Thyroid Eye Disease Treatment & Surgery

Trustpilot
woman with healthy eyes, close-up

consult the under-eye experts

Thyroid eye disease (TED) is an autoimmune condition linked to thyroid disorders. Symptoms include bulging eyes and impaired vision, but TED treatment is available in several forms including medication and surgery (like orbital decompression).

Key Information

PRICE

Call for more info

TIME OF PROCEDURE

Depends on several factors

DISCOMFORT LEVEL

4 out of 5

Book a consultation

Navigation

What Is Thyroid Eye Disease?

The thyroid is a hormone-releasing gland located in the neck. It exerts control over the body’s metabolic rate, or how quickly you turn food into energy that your organs and cells can use. In short, it has a big impact on overall health and bodily function, and if it doesn’t work correctly, due to disease or disorder, that can lead to a lot of consequences.

Thyroid eye disease, otherwise known as Graves ophthalmopathy or Graves orbitopathy, is one of those consequences. It’s an autoimmune condition affecting one or both (usually the latter) eye sockets. More precisely, it inflames the muscles and fatty tissues in the sockets. When they swell up, they push the eyeballs out of place, which may lead to visual impairments.

Who Does It Affect?

Lots of people of varying ages, but stats show that the most common patients are between 30 and 50 years of age. Females are more likely than men to have TED, and those with pre-existing thyroid or autoimmune conditions – like Graves’ disease, celiac, and lupus – are more at risk. As for how rare is thyroid eye disease, figures show that around 19 in every 100,000 people are impacted.

Book a consultation

What Are the Symptoms of Thyroid Eye Disease?

Symptoms of thyroid eye disease range from relatively mild ones, which can lead to this condition being mistaken for something less serious (like hay fever), to more dramatic ones.

The mildest symptoms include:

  • Irritation and itchiness of the eye
  • Light swelling around the eye

More serious symptoms are:

  • The feeling of grit or dirt inside your eye
  • Swelling of the eyelids
  • Bags beneath the eyes
  • Redness of the eyelids
  • Light sensitivity
  • Visual impairments, like blurred vision
  • Double vision, because of the muscles within the eye getting swollen and scarred
  • Dry eyes
  • Watery eyes
  • Eyes that bulge or protrude due to swelling
  • Eyelid retraction
  • Pain or discomfort in and around the eye area
  • Difficulty moving the eyes

The worst symptoms may include:

  • Partial or full vision loss
  • Inability to fully close the eyes to blink and sleep

How Is TED Diagnosed?

Given the range of symptoms of TED and how it can start mildly before getting much more serious, lots of people want to know how to test for thyroid eye disease and what are the first signs of thyroid eye disease?

Well, if you have any existing thyroid problems or other conditions putting you at elevated risk of TED, it’s worthwhile to make your GP aware of this and seek specialist consultations if you have any suspicions or symptoms.

Hormone specialists – endocrinologists – carry out thyroid function tests to track how well your thyroid works. Meanwhile, eye specialists – ophthalmologists – conduct eye exams and orbit scans (possibly including CTs or MRIs).

TED is complex. As such, a reliable diagnosis requires an array of tests, reviews, and assessments. Leading clinics, like The Ezra Clinic, have teams of varying specialists who carry out a range of investigations and provide prompt and precise TED diagnoses.

What Causes Thyroid Eye Disease?

TED can occur in people of any age and with varying states of health, and it’s not limited only to people with pre-existing conditions. However, it’s more likely to occur in those who have problems with their thyroids, like hyperthyroidism, or autoimmune conditions. It’s most prevalent in females and can occur during pregnancy.

Risk factors for TED include:

A family history of the condition or related problems, like Graves’ disease
Problems with hormone imbalances or autoimmune responses
Smoking (this can double your odds of getting TED)
Radioactive Iodine (A treatment sometimes used to treat an overactive thyroid)

Book a consultation

Stages and Treatment of TED

TED progresses in two distinct stages—the active phase and the inactive phase. As such, the best treatment approach depends on the stage of the disease when it comes to reversing it and reducing swelling.

At The Ezra Clinic, we lead the way in innovative surgical treatments for thyroid eye disease, using a holistic and team-based approach with a mixture of surgeons and specialists to provide patients with tailored, comprehensive treatment and rehabilitation services.

Early Active Phase

As the name implies, this is when the disease is essentially active and progressing. It’s also the best time to treat it and stop it in its tracks before it takes too much toll on the patient. Patients in active TED can experience pain, discomfort, inflammation, and dry eyes. This phase can last six months to two years.

Inactive or Chronic Phase

Also, as the name infers, this is when TED has ceased to progress and has, in effect, taken its toll on the eyes. Patients in this phase may exhibit mild to severe changes in physical appearance, best seen in thyroid eye disease before and after photos. They may also have vision impairment or loss at this stage.

Thyroid Eye Disease Treatments

Treatments vary based on the phrase.

Early Active Phase

Here, it’s all about treating and minimising the symptoms of the disease as it takes effect, thereby minimising its results on vision and facial features.

You can use eye drops or so-called artificial tears to ease dry eyes. Painkillers may be prescribed for soreness and headaches. And it’s best to keep the eyes covered with sunglasses to mitigate light sensitivity and irritation from weather, wind, and pollutants. Regular thyroid tests are encouraged, along with supplements to keep hormone levels in check.

Inactive or Chronic Phase

Once TED reaches the inactive phase, treatment is primarily about repairing or undoing the damage done. This typically involves surgical approaches, such as orbital decompression, eyelid lowering, or blepharoplasty. Combinations of these surgeries may be needed, depending on the levels of disfigurement and visual distress.

White woman before and after upper and lower blepharoplasty

Orbital Decompression Surgery

This is the go-to technique for treating TED patients with bulging eyes (or proptosis, to give the technical term). It involves removing bone and/or fat around the eyes to essentially make space for the eyeballs to sit further back in the head and protrude less.

Types of Orbital Decompression Surgery

Orbital decompression takes various forms. As such, orbital decompression surgery cost in the UK may vary based on the type required. And when it comes to questions like “How much is orbital decompression surgery?” and “What is healing time after orbital decompression surgery?” answers vary based on the approach employed.

Lateral Wall Decompression

A small incision is made through the upper eyelid before part of the eye socket bone is removed. The extra space required will then allow the eyes to move backwards.

Medial (Inner) Wall Decompression

Incisions are made in the interior corners of eyelids to take out part of the interior wall of the socket. No scarring is left. The wall may also be surgically removed through the nose, meaning that there are no scars.

Orbital Floor

Part of the floor or base of the eye socket (under the eyeball) is taken out. This can lead to temporary numbness, as local nerves are affected.

Balanced Two-and-a-Half Wall Decompression (Lateral and Medial Walls)

A combination of the lateral and medial procedures.

Fat Decompression

Fat around and behind the eye is taken out to reduce the overall volume of the eye socket, allowing the eye to move backwards.

Preparation for the Surgery

Patients should avoid aspirin, anti-inflammatories, or blood-thinning medication in the days leading up to surgery. On the day of the procedure, general anaesthetic is applied to numb any pain.

Aftercare – What Is the Recovery Process Like?

Post-op, you’ll have pads placed over the eye(s) which should stay in place for the first day. Painkillers are usually given to ease any soreness and aid with rest and sleep. Patients may also want to use extra pillows while resting, take a minimum of two weeks off work, and avoid any exercise, driving, strenuous activities, and even the likes of nose-blowing.

You’ll also have follow-up checks to see how the area is healing and address any additional issues or concerns that emerge.

Book a consultation

Thyroid Eye Disease Treatment in London

woman with thyroid eye disease
man with thyroid eye disease
man with thyroid eye disease
man with thyroid eye disease
man with thyroid eye disease

An example of the mixed changed associated with thyroid eye disease. This patient has left upper lid retraction, fullness of the eyelids and disordered eye movements leading to double vision.

One of the most debilitating symptoms of Thyroid Eye Disease is double vision. This occurs because some of the muscles that move the eye became scarred and fixed, meaning that the eyes can point in different directions. This patient is attempting to look upwards, but the scarred muscles on the left eye prevent movement.

This patient shows quite typical features of TED. The eyes are proptosed (bulging forward due to expansion of the fat behind the eye.) There is also marked upper eyelid retraction keeping the upper eyelid in a very high position. This combination of features contribute to an ‘angry’ look which TED patients often complain of.

Another example of typical TED signs, including bulging eyes due to fat expansion behind the eye and significant upper eyelid retraction, resulting in an ‘angry’ appearance frequently reported by TED patients.

This image is of a patient with highly active thyroid eye disease. The typical features of proptosis (bulging eyes), fullness of the eyelids and redness are all visible here. This patient was managed with medication only and made an excellent recovery

FAQ

What are the risks and side effects of orbital decompression surgery?

As with almost any surgery, there’s a risk of infection or bleeding, though this is rare. You can also experience eyelid swelling and possible light scarring.

How much does the surgery cost?

The cost of your surgery will vary significantly depending on the type of treatment required. Following your consultation, we will provide a detailed breakdown of the costs tailored to your specific needs.

Will I have scars after the treatment?

The likelihood of scarring depends on the surgical approach. Endoscopic procedures for decompression usually leave no visible scars. However, other types of surgery may result in scars, which are generally small and discreetly placed to minimise visibility.

How can I relieve the burning in my eyes?

Artificial tears or eye drops are good for this. Your specialist will be able to advise you.

How can I reduce the appearance of swelling?

Sleeping with your head elevated is a good approach to prevent fluid buildup, and try to reduce your salt intake.

Does nutrition have an effect on thyroid eye disease?

It certainly can. A healthy and balanced diet without excess salt is best for those with TED. Selenium supplementation is also beneficial for mild TED.

Can smoking increase the risk of having TED?

100%. Smoking can double or even triple your chances of acquiring TED much more than that of a non-smoker.

Will I require further surgery?

It’s impossible to say until the initial treatments are carried out and the results observed. Some patients may require follow-up surgeries.

Does orbital decompression surgery correct double vision?

It can, but double vision may also persist even with surgical intervention. Additional eye muscle surgeries or other approaches, like patching, can help with this.

Is it contagious?

Not at all.

What causes my eyes to bulge when I have TED?

It’s related to the swelling of sections of muscle and tissue behind and around the eyeball that essentially pushes the eye forward.