Once an overactive thyroid gland is suspected, the thyroid function must be evaluated and dysthyroidism (hyper-/hypothyroidism) treated by an endocrinologist. The eye disease may continue to progress after the thyroid function is treated and has returned to normal. Any residual eye problems should be followed and treated by an ophthalmologist if necessary. By own experience we recommend a multidisciplinary approach by endocrinologists and ophthalmologists with a Joint Clinic for all patients with sings and symptoms of Graves' Orbitopathy. In moderate to severe cases as well as in atypical presentations of Graves' Orbitopathy this combined approach is mandatory.

Two phases of eye treatment should be considered. The first phase involves treating the underlying thyroid dysfunction and the active eye disease. The active period, which usually lasts two or more years, requires careful and continuous monitoring until a stable state with euthyroidism and no residual signs of orbital inflammation is reached. The second phase involves correcting unacceptable permanent changes which persist following stabilisation of the active phase.

Treatment during the active phase of the disease focuses on maintaining euthyroidism and preserving visual functions. Medical treatment of eye disease, such as artificial tears and ointments, steroids, orbital surgery, and possible radiation (X-ray treatment) of the orbit, may be required. In the second phase, treatment of permanent changes may require surgical correction of eye protrusion, double vision (squint), eyelid retraction and «eyebags».

With rare exceptions surgery for thyroid eye disease is performed in the following sequence (although not every stage is required in every single case):

1. Orbital decompression
2. Eye muscle (strabismus) surgery
3. Eyelid repositioning surgery
4. Blepharoplasty

More Informations:
What is an orbital decompression operation?
What are the risks associated with orbital decompressive surgery?
Strabismus surgery
Eyelid repositioning surgery
What are the risks of eyelid repositioning surgery?
What happens after eyelid repositioning surgery?
Blepharoplasty
Are the results of surgery predictable?
What happens before surgery?
More Information
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