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Vision plays a major role in how you interact with the world, so eye problems can have a big impact on your quality of life. Thyroid eye disease (TED) can cause bulging eyes, double vision, and pain, among other distressing and uncomfortable symptoms.
If you’ve been experiencing symptoms like these and had no relief from other TED treatments, it might be time to consider surgery for thyroid eye disease.
TED is an autoimmune disease, which means your immune system attacks your healthy cells as if they’re harmful. TED commonly occurs with Graves’ disease, and it can cause inflammation in the muscles and tissues surrounding the eye. For some people living with Graves’ disease or TED, topical treatments or medications can relieve pain and other symptoms fairly well. But for others with TED, more advanced treatments like surgery might be necessary.
Three main types of surgery are used to treat TED: orbital decompression surgery, strabismus (eye muscle) surgery, and blepharoplasty (eyelid surgery). Here, we’ll offer a brief overview of each.
In orbital decompression surgery, a surgeon removes a small amount of bone or fat from the orbit (eye socket) to create more space for your eye. This can help reduce pressure, tearing, and abrasions (scratches). Orbital decompression surgery may also allow your eye to move back into place.
This type of surgery is usually best suited for people who have severe proptosis (bulging eyes) or are at risk of vision loss due to pressure on the optic nerve.
TED can also affect the muscles that control eye movement, causing diplopia (double vision). When your eyes are misaligned because the muscles are too tight or too loose, this is called strabismus (crossed eyes).
During eye muscle surgery, your surgeon will change the position of the muscles that control eye movement to help your eyes align correctly. If your eyes are misaligned and other treatments haven’t fixed the problem, strabismus surgery might be a good option.
TED can cause upper eyelids to pull back, making your eyes look too wide open. Eyelid surgery, also known as blepharoplasty, can help reposition your eyelids. This can allow your eyelids to close more comfortably and protect your eyes from dryness, irritation, or dry spots on your cornea.
During the procedure, your surgeon adjusts the position of your eyelids, which can involve either shortening or lengthening the muscles. This tends to help the eyelids close properly. The surgical team might need to make adjustments on your upper or lower eyelid or both.
TED consists of two main phases: active (or progressive) and inactive (or chronic). In the active phase, the eyes are more inflamed and undergo changes, which can last from six months to three years. In the inactive phase, inflammation has slowed and changes have stopped.
The inactive phase is a better time to consider surgical options because there’s less inflammation and symptoms aren’t getting worse. Surgery is typically avoided during the active phase because the eyes are still changing, so the results might not be as stable. Surgery could also be more dangerous or carry more risks during the active phase.
The length of recovery depends on the type of surgery performed. Be sure to talk with your surgeon about what you can expect after your surgery, in both the short term and the long term.
Immediately after orbital decompression surgery, you’ll likely have some swelling and bruising around your eyes. Pain, fatigue, and nausea are common but typically not too severe. Recovery usually lasts for a few weeks, although it could take a bit longer. Your vision might be blurry at first but will improve as you heal. Most people start to feel better within a few months, as their eyes start to look and feel more normal. Be sure to attend any postoperative visits that your surgeon recommends.
After eye muscle surgery, you should expect your eyes to be a little red and sore. You may still have some double vision, but eye alignment usually begins to improve after a few weeks. Full recovery could take up to 12 weeks.
Recovery from eyelid surgery is usually pretty quick — most people feel comfortable going about their daily lives within 10 to 14 days. You may have some swelling and discomfort, but this should go away within a week or two. Your doctor may recommend using a cold compress or prescribe an antibiotic ointment to use during the recovery period.
As with any medical procedure, surgery for TED comes with risks and possible complications. Before making final treatment decisions, you should be aware of possible difficulties and negative effects of the type of surgery you’re considering.
Orbital decompression surgery can be life-changing for some people with TED, but it’s important to be aware of the potential risks and complications. These can include:
Strabismus surgery is considered very safe, with a low risk of complications. However, problems such as the following can occur:
Before eyelid surgery, your surgeon will discuss all the potential risks with you. Possible complications include the following:
You may see a few types of doctors if you’re considering surgery or other treatments for thyroid eye disease.
Oculoplastic surgeons are ophthalmologists (eye doctors) with advanced surgical training. They specialize in surgery around the eyes and can perform orbital decompression, strabismus, and eyelid surgeries.
Endocrinologists specialize in the endocrine (hormone) system, including the thyroid gland. They’re not surgeons, but these doctors can make sure your thyroid levels are stable before and after surgery.
Be sure to talk with your health care team or an ophthalmology specialist about your specific needs and concerns. Together, you can decide whether surgery for thyroid eye disease is the right choice for you.
On TEDhealthteam, the social network for people living with TED and their loved ones, members come together to ask questions, give advice, and share their stories with those who understand life with TED.
Are you or a family member living with TED? What types of surgery have you considered to treat your symptoms of thyroid eye disease? Share your experience in the comments below, or start a conversation by posting on your Activities page.
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Paul B. Griggs, M.D.
is certified by the American Board of Ophthalmology.
Learn more about him here.
Zoe Owrutsky, Ph.D.
earned her Bachelor of Science from the University of Pittsburgh in 2014 and her Ph.D. in neuroscience from the University of Colorado Anschutz Medical Campus in 2023.
Learn more about her here.
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