Exophthalmos – Thyroid Ophthalmopathy

Area

Eye socket

Anesthesia

Yes

Surgery Time

  • Short
  • Medium
  • Long

50

Recovery Time

  • Short
  • Medium
  • Long

50

Rehabilitation Time

  • Short
  • Medium
  • Long

50

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WHAT IS EXOPHTHALMOS?

Exophthalmos or propotosis may be defined as a buldging of one or both eye globes beyond the eyelid margin.

In case of exophthalmos it is essential to consider some characteristics:

  • Extent: light, moderate, serious.
  • Onset: acute (suspect traumas, inflammatory processes, arteriovenous
    fistulas) or chronic (endocrinal or tumorous pathology).
  • Location: unilateral or bilateral (more common in an endocrinal pathology).

The most common cause of exophthalmos is Thyroid Ophthalmopathy. The disease, which affects mostly women between 20 and 60, is self-inflicted.

The most evident eye symptoms are: fixed gaze, reduced winking, eyelid retraction, chemosis or conjunctival redness, pain, tearing, irritation and sensitivity to light. At times additional symptoms may occur, such as seeing double (diplopia) and squint.


CAN I UNDERGO THE SURGERY?

The treatment of the exophthalmos is secondary to its etiology (cause): before any treatment it is essential to recognize the cause and attempt to address the cause, in collaboration with other specialists (endocrinologists, oncologists).

Patients who turn to an oculoplasty surgeon:

  • Patients who are self-conscious due to the eye buldging and refuse their own look, because of the unnatural ‘wide-eyed’ and ‘scared’ gaze which does not reflect how they really feel. In the unilateral cases the marked asymmetry of the gaze may be a source of a profound aesthetic and emotional discomfort.
  • Patients whose exophthalmos is accompanied by eye surface problems: disturbing sensation, excessive tearing, burning and itching, pain, even dreadful corneal ulcers.

WHAT DOES THE EXOPHTHALMOS TREATMENT CONSIST OF?

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The complete treatment of thyroid ophthalmopathy foresees 3 different surgeries in order to target different aspects of the pathology.

The orbital decompression and the correction of the squint are the first two steps towards a complete rehabilitation of the pathology.

In minor cases the retracted eyelid may be corrected through a mini-invasive transconjunctival technique (surgery of the inner side of the eyelid), which consists in an incision at the inner margin of the eyelid, with no visible scars.
On the lifting muscle or/and Müller’s muscle (upper eyelid), as well as lower retractor muscle (lower eyelid) it is possible to perform muscle weakening operations.
In some cases of a particularly severe retraction a graft from an autologous (oral mucosa, hard palate, cartridge, dermis) or heterologous (sclera from a donor) or synthetically built material may be needed.

Each patient will be advised and guided towards the most appropriate and advanced surgical practices, according to the latest guidelines by International surgical associations


WHAT CAN I EXPECT? WHAT ARE THE RESULTS OF THE EXOPHTHALMOS TREATMENT?

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The correction of the eyelid retraction represents the last surgical step in the therapeutical and rehabilitation process.
The operation allows for reducing the anomalous opening of the eyelid margin and obtaining a harmonious gaze thanks to a better eye symmetry.

The final result is a more effective eye closure, a correct eyelid position, and a less gaping and unnatural gaze

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