Eyelid Surgery in Thyroid (Graves' Disease) Patients

Neigel Center for Cosmetic and Laser Surgery

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Patients with thyroid eye disease (Graves' Orbitopathy) present special problems.

Thyroid patients should never undergo surgery when the disease is active but should wait one or two years until the disease has stabilized. Operations during the active phase can result in more bleeding and swelling, and both the patient and the surgeon will be disappointed with the results. (An exception is an orbital decompression). Eyelid surgery should be the last surgery these patients undergo in their rehabilitation.

Thyroid patients also take longer to heal from surgery and may require more local anesthetic. Bleeding, swelling and bruising can be reduced by laser surgery, resulting in faster healing time.

Thyroid patients may require several surgeries. For the first surgery, the patient may require orbital decompressions to make room to put the eyes back in the socket and correct the proptosis (bulging). Often, during a decompression, lower eyelid fat can be removed.

The next procedure, if needed, would correct diplopia, or double vision, with eye muscle surgery. The final procedure for rehabilitation would be correction of the eyelid retraction and blepharoplasty (removal of the remaining fat and bags and repositioning of the eyelids).

In thyroid patients, fat removal, not skin removal, is usually required. The extra fat in these patients can be quite extensive and involve more surgery than a normal blepharoplasty. Because the skin often becomes thicker and less elastic, the surgeon must be conservative in the skin excision and concentrate more on underlying fat removal. Even before surgery these patients often have trouble closing their eyes because of lid retraction and decreased elasticity. Removing too much skin can make this problem worse.

Insurance companies usually cover eyelid procedures on thyroid patients, but some will still argue that the surgery is cosmetic, despite the fact that the disfigurement has been caused by a severe medical disease. Again, check with your insurance company prior to surgery to ascertain coverage.