Big eyes (thyroid eye disease)

TED has changed the eyes. Although the inflammation had stopped, she was very unhappy about the changes that had changed her face to the extent that she was sevely depressed.

The orbital decompression operation has already changed her appearance 2 weeks after the operation. She has not finished the restorative surgery program yet, but is well on the way.

In most cases the bulging of an eye is due to thyroid problems, and associated inflammation of the eye muscles and some other tissues in the orbit (TED). Diagnosis is crucial in patients with a bulging eye, so as to exclude more serious disease. Bulging of an eye may less commonly be due to tumours in the orbit . In case of TED, assessment must make sure that the vision is not threatened. An eye plastic surgeon has had special fellowship training to recognise these problems in an early stage.

Treatment of TED must include restoring normal thyroid function, treating any active inflammation of the tissues behind the eye, protecting the eye and vision and eventually rehabilitation of the (sometimes grossly) changed appearance. Change in looks is very much still underestimated as a problem for the patient, and needs serious addressing by the treating doctor.I know of patients that have changed their life so that any social contact can easily be avoided. Many patients suffer with depression, which is another cause of social isolation. One would have thought that in the 21st century this would be something of the past! Fortunately many things can be done to rehabilitate patients, often to the extent that we may be able to restore them to their original looks.