I perform collaborative work with the endocrinology service, carry out a precise evaluation of the orbit, muscles, eyelids, and ocular surface, and finally establish an individualized plan according to the disease phase and patient symptoms.
THYROID ORBITOPATHY
Thyroid orbitopathy is the most common cause of “bulging eyes” in adults. It is an autoimmune disease that inflames the tissues of the orbit, narrowing the space for the eyeball. With early diagnosis and coordinated management between endocrinology and oculoplastics, we can protect vision and significantly improve the appearance of the eyes.
What is thyroid orbitopathy?
Although it is usually associated with hyperthyroidism (Graves’ disease), it can also occur with normal thyroid function or hypothyroidism. The inflammation causes:
- Exophthalmos (bulging eyes)
- Changes in eyelid opening
- Ocular discomfort
- Visual disturbances in more advanced cases
Common symptoms
- Dryness, grittiness, or burning
- Wide-open eyes or sensation of incomplete closure
- Swelling around the eyes
- Difficulty moving the eyes or double vision
- Light sensitivity
- Blurred vision in severe cases
My treatment approach
Active (inflammatory) phase
Period of progressive inflammation that can last from months to 1–2 years. Symptoms include: redness, pain, tearing, eyelid retraction, exophthalmos, double vision and, in severe cases, risk to the cornea or optic nerve.
Treatment in the active phase
- Thyroid control
- Artificial tears, gels, or ointments
- Nocturnal corneal protection if necessary
- Selenium supplementation in mild cases
- Intravenous corticosteroids in moderate or severe cases
- Consideration of immunomodulatory therapies
- Smoking cessation (key to progression)
Inactive or sequelae phase
Once the inflammation stops, the following may persist:
- Exophthalmos
- Retracted eyelids (upper lids too high or lower lids too low)
- Residual double vision
In this phase we plan reconstructive and functional surgeries.
Surgical treatment in the sequelae phase
Orbital decompression surgery
Reduces exophthalmos by expanding the space within the orbit through selective opening of bony walls.
- ANESTHESIA: general
- DURATION: 2-3 hours
- ADMISSION: less than 24 h
Surgical treatment in the sequelae phase
Eyelid retraction surgery
Corrects eyelids that are too open or too low.
- ANESTHESIA: local with/without sedation
- DURATION: 30 min per eyelid
- Outpatient surgery
Surgical treatment in the sequelae phase
Strabismus surgery (double vision)
Repositioning of ocular muscles when double vision is stable.
RESULTS
The results focus on both function and aesthetics, with the goal of protecting the cornea and vision, reducing pressure, irritation, and double vision, and restoring a natural and symmetrical appearance.
BEFORE AND AFTER
If you would like to see more results and videos of the process, follow me on Instagram
DO YOU HAVE QUESTIONS
The active phase is self-limiting, but it can leave sequelae. Specialized follow-up is essential.
No. Many mild cases do not require surgery. We operate when it significantly affects vision, eyelid closure, or appearance.
Lateral decompression is performed through a natural eyelid fold; medial and inferior decompression is performed internally. Minimal or no external scars.
Between 14-21 days in most cases, depending on the type of surgery and activity.
If you have ocular discomfort, eyelid changes, or “bulging eyes” due to thyroid disease, we can evaluate your case on an individual basis.
