Treatment: Eyelid surgery for TED 2017-10-12T10:23:11+00:00

Eyelid surgery for TED

  • Conditions Treated

    Proptosis
    Red and painful eyes
    Palpebral retraction
    Squint
    Double vision
    Swelling and redness around the eyes
    Watering eyes
    etc.

  • Treatable Areas

    Eyelid

  • Practitioner

    Doctor

  • Downtime

    You may require 10–21 days of downtime to recover as the orbit is likely to be swollen and bruised after decompression surgery. The recovery time after squint surgery is  7–10 days and 7–14 days after blepharoplasty surgery.

  • Prices

    Contact the clinic for more information about prices.

  • Your Specialist

Jane Olver

Consultant Ophthalmic Surgeon
Eyelid & Lacrimal Specialist

More about specialist

Eyelid surgery for TED

The Problem

TED has an initial active phase that lasts between 6 and 18 months. During this period it may worsen, then start to show some improvement spontaneously as it enters the inactive or stable phase. It should be monitored carefully by an oculoplastic surgeon.

Before eyelid surgery is considered there are non-surgical options.

  • Steroids

  • Low-dose radiotherapy

  • Lubricant eye drops

Talk to us about your options on 020 7935 7990

The best way to figure out whether this is something for you is to give us a call. We can answer any questions you have and help you clarify which treatment options are best for you.

Book a consultation

The Treatment

Non-surgical treatment of TED

Non-surgical treatment is planned according to the degree of thyroid activity, sometimes using steroids or low-dose radiotherapy.

Lubricant eye drops make the eye more comfortable and protect the cornea and should be used regularly by TED patients.

If visual function is severely threatened because the optic nerve is compressed, either a high dose of steroids or urgent orbital decompression is required.

Surgical treatment of TED

Surgical treatment is started when the disease is stable. TED surgery is used to correct the proptosis, ocular exposure, double vision and periocular and orbital bulging and eyebags.

Surgery is performed in the following order:

  1. Orbital decompression to correct eye protrusion and orbital bulging.
  2. Eye muscle surgery is performed to correct double vision.
  3. Eyelid surgery is performed to correct eyelid retraction.
  4. Augmented blepharoplasty to reduce eyebags and decompress orbital soft tissue.

Balanced Orbital Decompression Surgery in TED

Orbital decompression surgery reduces exophthalmos. This involves removing bone to enlarge the orbit. After decompression, the orbital contents expand inside the orbit. The floor of the orbit is preserved in order to avoid causing double vision, this is called a balanced orbital decompression. This is called a balanced orbital decompression. Orbital decompression allows the eye to sink back into the socket and resume a more normal appearance. Decompression also helps resolve optic nerve compression and restore normal visual function.

Orbital decompression surgery is done one side at a time under general anaesthetic by an oculoplastic surgeon. The incision to access the outer orbital wall is done in the upper eyelid, well hidden in the skin creases, extending a little beyond the eyelid. This results in a very natural looking scar that is barely visible. It enables the outer orbital wall to be drilled deeply and allow optimum decompression.

The balanced inner wall decompression into the ethmoid sinus is done via a small incision inside the eyelid which is called a trans-caruncular approach and does not leave a visible scar.
Inner wall decompression can also be done endoscopically via the nose by an experienced ENT sinus surgeon. This is a particularly useful approach for relieving optic nerve compression with reduced visual function.

Additonally, orbital decompression surgery often has a positive effect on eyelid retraction, meaning additional retraction surgery is less frequently required.

Eye Muscle Surgery for TED (Squint or Strabismus Surgery)

The small muscles that move the eyes may become enlarged as a result of TED. This can impede eye movement and cause double vision.

Squint surgery (strabismus surgery) is performed to reposition the eye muscles to provide the best possible field of single vision, allowing the eyes to function near normally. Squint surgery is only done once the thyroid eye disease activity and double vision measurements have stabilised. Whilst waiting for the double vision to stabilize a small plastic prism (Fresnl prism) can be placed on the back surface of glasses, to temporarily correct symptoms.

Squint surgery is performed under general or local anaesthestic and the eye muscles that are most scarred are delicately detached from the eyeball and reattached a few millimetres back using a small suture which can be adjusted as necessary wihthin the first 24 hours.

After surgery the eye may be patched for 24 hours and then a course of eye drops started for 3 – 4 weeks.

Eyelid surgery to correct eyelid retraction in TED

The eyelids can be repositioned to correct the eyelid retraction, making the eyes more comfortable and resulting in improved cosmetic appearance.

The upper eyelids are lengthened by the oculoplastic surgeon under local anaesthetic. To lenghten the lower lid it may be necessary to use a small tissue graft taken from the hard palate of the mouth or synthetic collagen (Alloderm® or Surederm®). If a hard palate graft is used, the surgery is best done under general anaesthetic.

Augmented blepharoplasty

Despite orbital decompression, patients with TED may be left with baggy eyelids and residual periocular and orbital swelling. A soft tissue decompression or augmented blepharoplasty can be done, where fat and a small amount of skin is removed.

Filler

Filler (hyaluronic acid gel, eg. Restylane®, Perlane®) is injected into the cheek to camouflage deep tear trough holllowing and malar atrophy. This helps improve cosmetic appearance and is done after the above functional surgeries.

General post-operative instructions:

  1. The eye is padded for 24 hours.
  2. The vision is checked a couple of hours after surgery and the eye is re-padded.
  3. Systemic steroid and antibiotic tablets are prescribed for between 5 – 10 days after orbital decompression.
  4. Topical eye drops are prescribed 4 times a day for up to three weeks.
  5. Ice packs are recommended to reduce swelling after orbital decompression and blepharoplasty.
  6. You should not drive for 48 hours after surgery. You should have someone accompany you home.
  7. You may require up to three weeks off work or “down time” to recover as the orbit is likely to be swollen and bruised for 10–21 days after decompression surgery. The recovery time after squint surgery is  7–10 days and 7–14 days after blepharoplasty surgery.
  8. You should not swim for three weeks.
  9. Follow-up is between 5–10 days after surgery when the vision and eye movements will be checked and sutures removed.

What our patients say

“Dr Jane Olver was fantastic! She was so caring and sweet and it was clear that she knew what she was doing – very professional! I am absolutely over the moon with my results now!”
TONI C. - REALSELF REVIEWS
“If you have a similar problem, Jane Olver is your woman – I wish I had found her at the start. I will be forever grateful for her care and expertise.”
Nancy W.
“Just wanted to thank you for your exceptional assistance with my eye condition. I was so worried but you really helped me feel at ease.”
David T.
“Thank you for your help during the year”
Julia S.
“Just a quick note for saying thanks for looking after my Mum so wonderfully as she was very worried about the appointment and you really made such a big difference to the experience.”
Sven K.
“Thank you very much for seeing me yesterday, you were marvellous and a pride to the NHS”
Mariah P.
“From the moment I met her to the moment I left, I was treated with great courtesy and kindness, and everything was explained to me in layman’s terms so I could fully understand my condition. I was immensely impressed.”
Paul
“Many thanks to Mr Khan. His prompt diagnosis and explanation was very reassuring indeed.”
Heather M.
“Just keep up the good work Dr Khan. My wife, who accompanied me, and I were both very impressed by the care and consideration shown by the whole team when I had surgery. I just hope they haven’t lost the knack by the time I get my other eye fixed. joking apart the care of this team has made it a wonderful experience for me.”
David S.
“Dearest Brian, Merry Christmas and a Happy New Year! Competent, sensitive doctors like you are the prize of the medical profession! I am so grateful that my experience was so positive. Love you Olga from Estonia”
Olga
“Dear Mr. Leatherbarrow and the Staff at Clinica London, Just a little not to say thank you very much for the great work you did to my eyes and the treatment I received. I am delighted with the results. Kind regards, Alexia M.”
Alexia M.
“Dear Professor Michel Michaelides , Thank you very much for your letter of the 4th September 2012. Ths means so very much to myself and Victor, during this terrible stressful time. Ever sind my first consultation with you, the caring dedication and understanding I have received from you has been priceless. Thank you with all my heart. Wishing you a healthy and happy future. Yours sincerely Doreen S.”
Doreen S.
“Dear Dr. Michaelides, I just wanted to express mine and my parents gratitude for arranging to see us all today and taking the time to answer all our questions. We left with a much greater understanding of the issues involved with genetic testing, the potential pattern of inheritance I have, and a renewed optimism over advances that could be happening in the field. It was also very helpful and reassuring to see Dr Amar again and be introduced to Jonathan the genetic counsellor – please do pass on our thanks to them as well. Yours sincerely Rachael S.”
Rachael S.
“Dear Professor Michaelides ,
Well done and thank you! You saw me last November for my annual RP assessment. You recommended to see the Glaucoma unit which I duly attended last week. (There was a delay because I had a cataract op in February)I do indeed have glaucoma as well as RP. Thankfully glaucoma is likely to be treatable with drops, so now at last the deterioration in my sight may be least partially arrested. I hope you will recommend to the retinal team that all RP suffers are tested for Glaucoma at fitting intervals. Yours sincerely, Edmund S.”
Edmund S.
“Dear Professor Michaelides ,
On behalf of my mother as well as myself, I would like to thank you for the consultation we had with you last Friday regarding my Usher Type 2/ RP condition. The knowledge and advice you shared with us was much appreciated. Today I received copy of the letter which you sent to my GP as record of the consultation. You might recall I mentioned that I have and indoor cycling frame which is great for an ex-road cyclist. If you should have any other patients who have to give up cycling on the road, I can recommend the “e-motion rollers” which is an American product and allows cyclists to ride their actual bike without modifications – suitable only for road bikes with high tyre pressure. Kind regards, Chris B.”
Chris B.
“Thank you for this, it’s nice to know you got the information you needed and were treated with respect. The team at Clinica London are good and the key thing, as you say, is seeing someone with the speciality in retinal degeneration. David “
David
“Dear Michel, My wife and I wish to thank you for your kindness and attention with regard to my poor eyesight. Your caring attitude and honest approach to help relieve my problem and find the best solution is overwhelming. And it is with this in mind we would like to express our sincere thanks for everything you have done for me. Kind regards, Maurice K”
Maurice K.
“Mr. Reddy was extremely kind and his special ‘duck’ noises certainly helped catch Talia’s attention and helped his examination run smoothly. Mr. Reddy informed us that Talia’s squint was severe and that glasses would not help her. He explained that she would need surgery. We have recently seen Mr. Reddy and the Orthoptist for a follow up and everyone involved is really pleased with the results of the surgery, most of all it seems is Talia.”
Rebecca and Daniel Corney
“What I loved most was her willingness to take my knowledge of my disease and experience into consideration. I am very impressed and feel lucky to be in her care.”
Fiona M.
“Dr Crawley is always in such a good mood and always does her utmost to help. Best doctor I have ever seen!”
Matthew K.
“Dr Crawley has a wonderful manner, is clearly knowledgeable and is an asset to the hospital.”
Lisa A.
“Thank you for forwarding the medical report. Please convey my thanks to Jane, I was deeply impressed by the politeness and empathy shown to me. I found the surgery very peaceful and beautifully decorated and I hope to see Jane again soon.”
Jeffrey W.
“Dear Jane,
I just wanted to say thank you for seeing me at such short notice. I felt much better after speaking to you and being reassured. I am much calmer and actually got some sleep last night.
I would also like to thank Ingrid, who was so lovely and very professional.
Best wishes, Catherine M.”
Catherine M.
“Thank you for forwarding the medical report. Please convey my thanks to Jane, I was deeply impressed by the politeness and empathy shown to me. I found the surgery very peaceful and beautifully decorated and I hope to see Jane again soon. Jeffrey W.”
Jeffrey W.
“I highly recommend Jane Olver. The whole experience was calm,and highly professional..”
Lorraine M.

“Dear Both,

Many thanks for taking care of my ptosis surgery today.
I am now back home and resting but wanted to send a quick note to thank you for taking such good care of me.

Many thanks, Charmaine”

Charmaine

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