Thyroid eye disease is a common problem in patients who have an underlying thyroid condition, both hypothyroidism as well as hyperthyroidism. The eye part of the condition is an autoimmune process where the body sees areas around your eyes as being ‘foreign’ and therefore attacks the tissues. More specifically, the muscles and soft tissues around the eyes become inflamed and infiltrated. This has many affects on the eyes and eyelids including problems with eye movements, double vision, exposure problems, dryness, a bulging appearance of the eyes (called Exophthalmos), improper position of the eyelids (called Eyelid Retraction), and in some cases, compression of the optic nerve leading to vision loss. Given all of these difficulties, thyroid disease is a chronic disease process which requires regular care and attention. These patients are best taken care of by a combination of physicians including a primary care provider, an endocrinologist, an ophthalmologist, and an oculoplastics specialist. Patients with thyroid eye disease often benefit from surgery to reposition their eye muscles and/or eyelids. In severe cases where their eyesight is at risk, a combination of steroid treatments, radiation, and surgery called orbital decompression may be necessary to preserve vision. Orbital decompression creates more space in the orbit and helps to place the eye back into its natural position which can significantly improve the appearance, can improve the health of the eye if exposure related problems are present, and can preserve vision. This type of surgery typically requires overnight stay in the hospital.
Tumors can occur around or behind the eye in the orbit. The orbit is a small space with crucial elements for vision and eye function, including the optic nerve and eye muscles. Tumors can be longstanding and benign or they can present with rapid growth with the potential for malignant spread. Furthermore, tumors of the orbit may originate in this location, or they can result from spread of cancer from other parts of the body. Orbital tumors typically present as a patient or their family may notice asymmetry in their appearance with one eye seeming to bulge forward which is called proptosis. Sometimes orbital tumors can lead to double vision, pain, or in severe cases, loss of vision due to compression of the optic nerve. Some orbital tumors can be followed over time for any changes, but some tumors may need to be biopsied and removed with surgery. Depending on the tumor type, co-management with an oncologist is sometimes recommended. If surgery is recommended, due to the orbit’s proximity to the sinuses and the brain, occasionally a patient with an orbital tumor will need to also be evaluated and treated by an ENT specialist or a neurosurgeon, and a team approach may be most appropriate for removal of the tumor.
Injury to the orbit can occur in the setting of blunt injury, sports injuries, or motor vehicle accidents. Orbital fractures present a unique challenge due to their proximity to the eye. An Oculoplastics specialist is best suited for evaluation of such injuries. Approximately half of orbital fractures may not require surgical repair. However, in some cases, repair of the fractures is indicated to restore the natural positioning, function, movement of the eye. Similar to orbital tumors, due to the orbit’s proximity to other structures including the sinuses, midface region, the mandible, and the brain, other surgeons (such as an ENT specialist, a neurosurgeon, an oral maxillofacial plastic surgeon, or a general plastics surgeon) may be involved and a team approach to repair may be recommended.
A number of conditions which can be present at birth involve the eyelids, the lacrimal system, and/or the orbit. Examples of this include congenital tumors, ptosis, nasolacrimal duct obstruction, eyelid and orbital malformations, microphthalmos, anophthalmos, and craniofacial anomalies. Some of these conditions are treatable with surgery and can improve a patient’s activities of daily living, aesthetic appearance, or quality of life. Several of these conditions may be part of underlying syndromes involving multiple organ systems. In these cases, a team approach with other specialists may be recommended.