Thyroid eye disease

Thyroid eye disease is an under diagnosed condition. Many patients are not diagnosed till late in the disease, when there are serious problems due to the disease. The eyes are usually red and congested. There is persistent watering from the eyes. The lids start to behave abnormally with widely open eyes which gives an angry look to the patient. The movements of the eyes can also get limited when the patient starts getting double vision. Protrusion of the eyes occurs due to the increase in fat in the orbit and enlargement of the eye muscles. The vision may drop when there is compression of the optic nerve by the eye muscles.

The serious manifestations are loss of vision and double vision. The treatment in the initial stages when the eyes are red is giving oral steroids or intravenous steroids so that the patient can tide over the inflammation or redness in the eyes.

Control of the thyroid status is also essential for the eye disease to become stable. For the double vision one can give prisms or even injection of botulinum toxin in the acute stages. Orbital decompression is needed if there is sight threatening optic nerve compression or for cosmetic reduction of the proptosis. Squint surgery may be needed for the double vision especially as there may be vertical displacement of images and adjustable sutures are used while performing the squint surgery.

I routinely perform surgery and manage many patients with thyroid eye disease, with a good outcome.

Need for Oculoplasty

Is there a need for an oculoplasty surgeon? Well to admit frankly, my personal experience is that the plastic or neurosurgeon or even the maxillofacial surgeron is reluctant to touch the eye ball or surrounding areas. My personal experience especially when managing serious conditions like orbital fractures is that the non ophthalmic surgeon is very comfortable when the ophthalmic surgeon is around.

The eye is a small organ in a small space with many structures all around. The importance of the eyes cannot be understated. The nose and the ears are not as important as the eyes. One argument in my favour is the way the nerves from the brain are organized. There are 12 cranial nerves, of which about 4 nerves are dedicated for supplying the eyes. The optic nerve can be considered the most important and is deeply interlinked with structures in the brain. The other nerves the 3rd, 4th and 6th nerve supply the muscles  of the eyes. In other words, of the 12 cranial nerves, 4 are exclusive to the eyes.

Need I say more about the importance of the eyes. Hence I do understand the importance of oculoplasty ... more in not creating new problems for the patient and also to ensure none of the important visual functions are disturbed...

Oculoplasty is here to stay and will be established soon...

RIGHT TO LOOK GOOD

I think everyone has a right to look good. Life is lop sided, there the good things and the bad things happening to us. I have seen many patients with thyroid eye disease who have been normal and who have suddenly started looking different with protruding eyes and angry staring look. It is important for them to understand that it is possible to make them look normal once their thyroid eye disease is under control. I guess that is how it works.

Even the squints are easy to manage and one can make the patient look good with the treatment and the surgeries. So one does not need to lose hope. Every individual has a right to look good and with excellent options now available it is possible to make it happen...