Thyroid Eye Disease

Hyperthyroidism (Grave’s disease) is a condition in which there is overproduction of thyroid hormones. Many patients start experiencing eye problems as soon as their thyroid gland becomes overactive. For some, the eye changes may develop before hyperthyroidism is detected, while others may not develop symptoms until months or years later. Both eyes are usually affected. However, they may not be affected to the same degree.

Signs and Symptoms

Common symptoms are pressure around the eyes, ocular irritation, dryness and tearing. 

Inflammation of the eye muscles may result in restricted eye movement causing double vision. If the muscles become too swollen, the enlarged muscles can compress the optic nerve, resulting in progressive visual loss. If you are experiencing vision loss or a change in your vision, please consult your local optometrist or general ophthalmologist. 

After several months and up to two years, the active inflammation subsides. Many patients will be left with some degree of eyeball protrusion, double vision, lid retraction, lid ptosis and eyebags.


For many people with thyroid eye disease, the ocular surface discomfort can be treated with topical lubricants such as eye drops, gels or ointments. Wrap-around tinted glasses are also helpful when going outside. 

When there is active inflammation that threatens vision, topical and oral steroids and other anti-inflammatory medications may be needed.  This can be prescribed by your local eye doctor. Radiation is sometimes used to treat active inflammation as well. If the swelling behind the eye is severe enough, surgery may be necessary to decompress the orbit.

The function and appearance of the eyes can usually be improved by reconstructive eyelid or orbital surgery. Surgical treatment is generally delayed until the active inflammation subsides. The particular surgical technique used will depend on the type and severity of the eye problems.

Orbital decompression (removing part of the bony orbit and fat behind the eye to relieve pressure within the eye socket) can prevent damage to the optic nerve, and allow the eyes to move back into a more normal position in the eye socket. Note Dr. Maleki does not perform orbital decompression surgery. Please have your doctor refer you to an orbital surgeon. 

Misalignment of the eyes and double vision can be improved with eye muscle surgery to reposition the enlarged muscles that control eye movement. Please note Dr. Maleki does not perform surgery for double vision. Please have your doctor refer you to a strabismus specialist. 

Dr Maleki is an oculoplastic surgeon that specializes in cosmetic and reconstructive eyelid surgery. For example, Dr Maleki can perform eyelid surgery to adjust the position of retracted eyelids. When eyelids are retracted, the white part of the eye may be visible above or below the coloured part. This makes the eyes look “surprised” or “startled”. Correcting the retraction makes the eyes appear smaller. It also improves eyelid closure and restores eyelid function. Often the dry eye and tearing symptoms improve with correction of the eyelid position. 

Sometimes with Thyroid Eye Disease, one or both eyelids can become droopy (lid ptosis).  Dr Maleki has extensive experience correct these types of eyelid malposition issues. If there is an excess amount of fat in the eyelids, this can be either removed or repositioned to areas that have volume deficiency. This improves the overall appearance of the eyes making you look better rested and less tired.

If you have any questions about the above eyelid procedures, schedule a consultation with by Dr. Babak Maleki, a board-certified ophthalmologist and oculoplastic surgeon with extensive training and experience in cosmetic and reconstructive eyelid surgery. 

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