Thyroid Eye Disease (Graves’ Disease) Orbital Surgery
Deciding When Surgery Is Right for You
Many patients manage thyroid eye disease with medication and monitoring, but sometimes surgery is the best path forward. We look for specific changes in your eye health to determine when to move from medical treatment to surgical solutions.
We monitor your condition closely while you are on medication. If your symptoms persist even after your thyroid levels are stable, we may discuss surgery. Common warning signs include eyes that still bulge forward, eyelids that do not close completely at night, or constant pressure behind the eyes. Double vision that makes it hard to drive or work is also a strong reason to consider a surgical plan.
In rare cases, surgery is urgent to save your sight. If swollen tissues in your eye socket press too hard on your optic nerve, it can cause permanent vision loss. We treat this aggressively with medication first, but if your vision does not improve quickly, we recommend urgent surgery to relieve the pressure.
- Noticeable loss of color vision or dimming sight
- New blind spots in your field of vision
- Swelling that does not get better with steroid treatment
- Damage to the front surface of the eye from being unable to blink fully
Before we plan an operation, we explore medical options to reduce inflammation and protect your eyes. These treatments are most effective during the 'active' phase of the disease when inflammation is high.
- New medications like teprotumumab that target the disease directly
- Intravenous steroids to calm severe swelling
- Specialized radiation therapy for the eye socket
- Prism glasses to help manage double vision
- Moisturizing therapies and bandages to protect the cornea
You do not have to wait for vision loss to consider surgery. Many patients choose surgery to improve their quality of life. Bulging eyes can affect your self-esteem, and constant irritation can make daily tasks difficult. We listen to your personal goals and help you decide if surgery can improve your daily comfort.
Thyroid eye disease typically has an active phase involving inflammation, followed by a stable, inactive phase. Unless there is an emergency threat to your vision, we usually wait until the disease is inactive before operating. This waiting period helps ensure your surgical results are stable and predictable.
Your Evaluation at ReFocus Eye Health Marlton
Our office in Marlton uses advanced technology to evaluate your eyes before any procedure. We take the time to understand exactly how the disease has affected your unique anatomy.
We perform a detailed exam to measure the position and health of your eyes. This includes checking how far your eyes protrude and how well your eyelids function.
- Precise measurement of eye bulging using special tools
- Testing to see if your eyelids close completely
- Checking the surface of your eye for dryness or damage
- Measuring eye alignment and movement
We use modern imaging, such as CT scans or MRI, to see the structures behind your eyes. These scans show us the bones, muscles, and fat within the eye socket. This 'map' helps our ophthalmologists plan the safest and most effective surgical approach for you.
We establish a baseline for your vision to track your progress. This involves testing your central vision, peripheral vision, and color perception. We also map out your eye muscle movements to identify exactly where you experience double vision. This data is critical if muscle repositioning is part of your surgical plan.
Your eye health is connected to your overall thyroid health. We coordinate with your endocrinologist to ensure your thyroid hormone levels are stable before surgery. We also discuss lifestyle factors that influence healing, such as the importance of not smoking and managing blood sugar levels.
Every patient has different priorities. Some want to fix double vision, while others focus on reducing the bulging appearance of their eyes. We have an honest conversation about what each procedure can achieve so you know what to expect.
Surgical Options for Thyroid Eye Disease
Our multispecialty team offers several types of surgery to address the different effects of thyroid eye disease. Often, these are done in stages to achieve the best outcome.
This surgery creates more space in the eye socket (orbit). By removing small amounts of bone or fat, we allow the eye to settle back into a more normal position. This relieves pressure on the optic nerve and helps reduce the bulging appearance. It can also make it easier for your eyelids to close properly.
Thyroid eye disease can cause eye muscles to become tight and scarred, leading to double vision. Our specialists can reposition these muscles to align your eyes. The goal is to help your eyes work together again so you can see a single, clear image when looking straight ahead.
The disease often causes the upper eyelids to pull up and the lower lids to sag. This creates a 'stare' appearance and leaves the eye exposed to air. We can surgically adjust the position of the eyelids to improve your appearance and protect the surface of your eye.
If you need more than one type of surgery, we typically perform them in a specific order. We usually start with orbital decompression, followed by muscle surgery, and finally eyelid surgery. This staged approach allows us to adjust the plan as your eyes heal, ensuring the most precise final result.
What to Expect During Your Procedure
Most surgeries are performed in a surgery center or hospital setting. Our team ensures you are comfortable and safe throughout the process.
For orbital decompression, you will be under general anesthesia, meaning you are completely asleep. Muscle and eyelid surgeries may use general anesthesia or sedation with local numbing medicine. We will discuss the best option for your specific procedure and health history.
Your surgeon makes incisions that are usually hidden in natural creases or inside the eyelid. Through these small openings, we carefully remove or reshape bone and fat to expand the space behind the eye. We work with great precision to protect the nerves and muscles nearby.
For muscle surgery, we access the eye muscles through a small opening in the clear covering of the eye. We detach the tight muscle and reattach it in a new position to improve alignment. In some cases, we use adjustable sutures that allow us to fine-tune the position shortly after the surgery.
Most patients return home the same day as their surgery. You will spend some time in our recovery area while the anesthesia wears off. You must have a friend or family member drive you home and stay with you for the first 24 hours.
Recovery and Life After Surgery
Recovery is a process, and our team in Marlton is here to support you every step of the way. We serve patients from across the Greater Philadelphia Metropolitan Area, providing close follow-up care to ensure you heal well.
Swelling and bruising are expected after surgery and usually peak after two or three days. Using cold compresses initially, keeping your head elevated, and taking prescribed medications will help manage these symptoms. Most swelling improves significantly within a few weeks.
We will prescribe ointments or drops to prevent infection and control inflammation. It is important to avoid rubbing your eyes. If you have stitches, we will give you specific instructions on how to keep them clean until they dissolve or are removed.
If you undergo orbital decompression, you must follow special sinus precautions. These steps protect the surgical area and prevent complications.
- Do not blow your nose for at least two weeks
- Sneeze with your mouth open to reduce pressure
- Avoid using CPAP machines until cleared by your doctor
- Delay air travel for a short period after surgery
Most patients take one to two weeks off from work or school. You should avoid heavy lifting, bending over, and strenuous exercise for several weeks. We will let you know when it is safe to resume activities like swimming or wearing contact lenses.
We will see you regularly after surgery to check your healing and vision. Final results take time as the swelling fully resolves. If you are having staged surgeries, we will monitor your stability before scheduling the next phase.
While complications are rare, you should contact us immediately if you experience vision loss, severe pain that medicine does not help, or a sudden increase in swelling. Signs of infection, such as fever or redness, also require a prompt call to our office.
Frequently Asked Questions
Surgery treats the eye problems caused by the disease, but it does not cure the underlying autoimmune condition. You will need to continue seeing your endocrinologist to manage your thyroid health while we focus on your eyes.
If the optic nerve is compressed, surgery can prevent further vision loss and may help restore some vision. The amount of improvement depends on how severe the damage is and how quickly it is treated.
For non-emergency cases, we generally wait three to six months after your thyroid levels and eye symptoms have stabilized. This reduces the risk of inflammation returning after the procedure.
Decompression surgery is very effective at reducing bulging. While some patients achieve a near-normal appearance, others see a significant improvement but may still have mild prominence. We set realistic expectations based on your specific anatomy.
Yes, medications like teprotumumab are available for eligible patients during the active phase of the disease. These drugs can reduce bulging and double vision, potentially reducing or eliminating the need for surgery later.
Yes. Smoking is a major risk factor for severe thyroid eye disease. It makes the disease harder to treat and increases the risk of complications during and after surgery. Quitting is one of the best things you can do for your recovery.
Getting Help for Thyroid Eye Disease Orbital Surgery
Thyroid eye disease is a complex condition, but you do not have to face it alone. At ReFocus Eye Health Marlton, we are dedicated to helping patients throughout New Jersey and the Philadelphia region protect their vision. We invite you to schedule a consultation to discuss a personalized plan that helps you feel like yourself again.
From the moment I reached the front desk to the technician who did my testing of my eyes to Dr. glass who was wonderful and to Katie, his assistant I knew I was in good hands from start to finish
Roslyn Soffer
Dr. Heuer was awesome. She’s efficient, friendly and thorough. She answered all of my questions patiently.
Mike Dibenedetto
Always a good experience. Dr. Grossman takes time to explain everything. No question is a bother to him.
Dennis Guida
Caring thorough employees. Dr Grossman is the best! Always a good experience with such a great caring doctor and his competent caring staff
Marilyn Zolnowski
Love this place and my doctors! Dr Glass and Dr Johnson !! Also the staff are wonderful
Carol Webb
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Sunday: Closed