Graves’ Disease Eye Surgery
Endoscopic orbital decompression is a surgery to treat Graves’ orbitopathy (thyroid eye disease). It removes the middle and bottom walls of the bone surrounding the eye. Surgeons use endoscopes and small instruments working through the nose.
Removing these walls allows us to expand the swollen tissues in the eye into the sinuses. This reduces the bulging appearance of your eyes.
Sometimes, depending on the extent of the disease, the surgeon will need to decompress the outside wall of your eye as well. This is done through a small incision on the side of the eye toward your forehead.
At University of Utah Health, endoscopic orbital decompression surgery is done with a team of surgeons trained in both orbital and sinus surgery.
Treating Graves’ eye disease is done through a coordinated multi-specialty practice between endocrinologists, ophthalmologists (eye doctors), and rhinologists (endoscopic sinus surgeons). It is important to be seen and evaluated if you have Graves’ orbitopathy because, in rare cases, it can affect your vision.
Benefits of Endoscopic Orbital Decompression
By removing part of the walls of the eye bones (or orbit), endoscopic orbital decompression may allow the eye to move back into a better position in the eye socket. This may:
- Reduce eye dryness
- Reduce tearing
- Reduce abrasions of your eye
- Affect even the appearance of your eye
Endoscopic orbital decompression may also decrease the pressure inside your eye socket. This can prevent or improve double vision or loss of vision.
While it's difficult to estimate success rates because each patient is very different, this procedure is worth discussing with your surgeon.
Surgery Risks
Endoscopic orbital decompression involves operating both in the eye and in the sinuses. Risks include but are not limited to the following:
- Loss of vision
- Double vision
- Inadequate decompression of the eye
- Bleeding around the eye
- Cheek numbness (from damage to the cheek nerve)
- Nosebleeds
- Leakage of brain fluid (cerebrospinal fluid/CSF)
- Meningitis
- Infection of the eye
- Injury of the tear duct (which can cause excess tearing)
- Sinusitis
Frequently Asked Questions about Graves' Disease Eye Surgery
- My doctors tell me they fixed my thyroid and that it is now normal. Why are my eyes acting up?
- The steroids made my eyes much more comfortable. Can't I just continue taking them?
- Why can't you fix my eyelids now?
- Can't you just put my bulging eyes back in place?
- Why do you want to operate on my "good" eye?
In Graves' disease, the immune system stimulates the thyroid gland to secrete too much hormone. This excess hormone results in nervousness, palpitations, weight loss, diarrhea, tremors, and a feeling of being hot all the time. Treatment is aimed at limiting the thyroid gland's ability to make thyroid hormone. This may be done with medications, surgery, or radioactive iodine, usually resulting in thyroid hormone production normalization (occasionally requiring thyroid replacement). However, this does not affect the primary auto-immune process, and the immune system may continue to target other tissues, particularly the extraocular muscles in the eye and eyelid. Orbital symptoms may even worsen following treatment with radioactive iodine. The eye and orbit changes are treated separately.
What to Expect After Endoscopic Orbital Decompression Surgery
Side Effects
Bleeding
Oozing from the nose is common for 24-48 hours following surgery.
Nausea
Nausea and even vomiting following anesthesia are common. The nausea usually fades after about 12-24 hours. You can try to sip liquids to avoid dehydration during these periods.
Pain
Some discomfort following the procedure is to be expected but usually is not especially severe.
Fatigue
Fatigue for two or three days following the surgery is common. You will want to take it easy for a few days following surgery. You should also avoid strenuous physical activity. Moderate activity (like going for a walk) is acceptable.
Aftercare Instructions
Medications
You should have received prescriptions for medications to take after surgery. Typically, these include pain medicine and possibly antibiotics. These medications are essential components of your care, promoting rapid and correct healing.
Irrigating
This is one of your most important jobs after surgery. The crusting of blood and mucus can slow the healing process. To keep your nose moist and prevent crusting, you should use saline (salt-water) nasal irrigation following surgery. A simple system to use is NeilMed’s Sinus Rinse, available at many pharmacies.
Post-Operative Visits
The care of your sinuses and orbit surgery does not end when the surgery is completed. Post-operative visits are critical. During these visits, your physician will examine your nose. Removal of dried blood and mucus may be necessary while the nose regains its ability to care for itself.
Recovery Timeline
Healing
The majority of the healing in your nose will take place over the next four weeks. In some patients, the process can take longer.
Work
Most individuals return to work within a week following surgery. Some return earlier, some later. Plan to be out for a week and return as soon as you feel up to it.
Travel
Many of our patients travel from some distance. If possible, it is helpful to stay in the local area overnight following the surgery. If necessary, you may travel by air 48 hours after the surgery.
View the Surgical Team
Call 801-585-6541 or
Learn More About the Utah Thyroid Eye Disease Program (UTED)