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  • Beebah
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      Four questions: I have Graves Disease, take methimozole and at present my thyroid is stabilized. As my one eyes has started bulging a little and is now bigger than the other, my doctor recommends the following: after having a cat scan to see what the muscle behind the eye is doing, he suggests inserting tissue into that lid to build it out and tightening/lifting it. This will improve appearance and stop my eyes from getting so dry. This dryness has resulted in my scratching my cornea while sleeping, despite ointment. Has anyone had this done or have thoughts on this?

      Secondly, as I suffer from dry eyes, he also wants to cauterize my lower tear ducts during the operation. Punctal plugs have not worked. One advantage, I will be in twilight and not need to have the numbing shot, which I hear is painful. Has anyone had this done, and are you pleased with the results. Do you feel the finished cauterized area?

      I also have double vision at night when tired and watching TV when I tilt my head one way. Will this ever go away?


      Online Facilitator
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        Hello and welcome! We are fellow patients, not doctors, but I am concerned that your doctor is recommending jumping right into surgery for your eye bulging.

        This page from the International Thyroid Eye Disease Society does a nice job of explaining the course of thyroid eye disease:

        Unless you are having vision issues due to compression of the optic nerve, surgeons do not want to operate on someone with thyroid eye disease until the disease is fully stabilized (not getting either better or worse). For eye bulging, the more common procedure is an orbital decompression, and then they will do surgery on the lids if that is still needed.

        The punctal plugs and cauterization *can* be used for dry eye, but honestly, I would seek a second opinion, as you might not have a doc who is really familiar with Graves’ disease. The American Society of Ophthalmic, Plastic, and Reconstructive Surgery has a search engine where you can locate a doctor near you:

        As thyroid eye disease runs its course, it *is* possible for some improvement to occur, although it is difficult to predict how much. It’s especially important to avoid smoking and second-hand smoke, as smoking is a known risk factor for worsening TED.

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          Post count: 305

          Lower punctum cautery worked great for me. I have the eye disease and have had many corrective surgeries once the eye disease burned out, i.e. symptoms like double vision, lid retraction, inflammation had not changed at all in six months. You do not want to do lids if you might need surgery to correct double vision or decompression surgery for enlarged eye muscles. Lids are usually done last. The punctal occlusion is quick and easy and has helped me with dryness. That will not interfere with future surgeries if needed.

            Post count: 1909

            Agree with Liz. I had the very same experience. As Kimberly and Liz both said, you must wait until TED has subsided and your eyes are not changing anymore. Otherwise the surgery will have to be repeated. I found the punctal plugs helpful in one eye, not the other, IT is fine to try, not risky, and does not shut any doors.

              Post count: 2

              Thanks for the responses. The doctor prescribed a cat scan. Will that tell him if the TED is in remission and symptoms will not continue?

                Post count: 305

                CT scan will only tell you how large the muscles are. If you had an earlier CT when eye was bulging, it will tell you if muscles size has increased. Eyes bulge because muscles get big and push eyes forward. Sometimes eyes look like they are bulging but it is actually the lids retracting. CT will not tell you if TED has burned out. Muscles that have enlarged and have fibrosis generally will not return to previous size. Only very mild TED can see any change in muscles. The only sure way is to not see any changes in your eyes for at least six months or so. Some people see improvement which eventually stops, but with moderate or severe TED, things just stop getting worse. I assume you are seeing an oculoplastic surgeon. If your eyes bulge more after you have lid surgery or you end up needing orbital decompression to put the eyes back in place ( make room for big muscles) and thus correct bulging, your lids would need to be redone.

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