Thyroid eye disease (TED) occurs in around around 40 percent of people with Graves’ disease.

Depending on the type of TED you have and the severity of symptoms, different treatments are available. Surgery may be needed if TED is affecting the function or structure of your eyes.

Intervention may be required if you have symptoms like:

  • swelling of your eyelids or eyeballs
  • pain with eye movement
  • pressure on your optic nerve

Surgeries include:

  • orbital decompression
  • strabismus (eye muscle) surgery
  • eyelid surgery

Read on to find out more about these surgeries and what to expect for each.

Excessive swelling behind your eye can put pressure on your optic nerve and affect your vision. Your eye may even get pushed forward in the socket.

In this procedure, a surgeon will remove bone or fat from behind your eye to create more space for your eye.

This will reduce the pressure on your optic nerve, protecting your vision. It also allows your eye to properly return to its position in the socket.

Recovery

This surgery happens under general anesthesia. The use of minimally invasive techniques has helped shorten recovery time.

The cuts made in this surgery are hidden, and there’s no visible scarring. You’ll likely be able to return to normal activities within 1 to 2 weeks.

Side effects

Orbital decompression doesn’t always improve double vision. And in some cases, double vision starts to occur after orbital decompression.

Eye muscle surgery or wearing glasses with a prism can help manage double vision.

Cost

The cost of the surgery will vary depending on your individual case and where you have it performed.

For many people with TED, this surgery is required for medical reasons. So, it’s typically covered by insurance.

Outlook

Orbital decompression surgery improves your eye’s appearance and function.

If other eye surgeries are needed, orbital decompression surgery is done first. Usually, surgeries are 2 to 4 months apart to allow time to heal in between.

The damage from active TED can cause scar tissue to build up on your eye muscles. Scar tissue can shorten eye muscles and limit movement of the eye, resulting in misalignment.

Strabismus surgery fixes this. During the procedure, a surgeon cuts damaged muscles, then reattaches them to your eye.

This returns your eyes to their correct position and restores a normal range of movement.

Recovery

This surgery is typically done under general anesthesia. Stitches used to reattach the muscle will dissolve in about 6 weeks. You’ll likely be back to normal activities within 1 or 2 weeks.

Side effects

It’s normal for eyes to be red, irritated, and watery for a few days as you recover from surgery.

Double vision may be present after surgery as well, as your brain adjusts to the new positioning of your eyes. This will improve over the days and weeks to come.

Cost

The cost of this surgery will vary depending on your individual case and where you have it done. It’s typically covered by insurance if it’s needed to correct vision and eye position.

Outlook

This surgery can be quite effective for treating double vision.

You may be given some eye strengthening exercises to help with recovery. You may also need to continue wearing glasses with a prism during the recovery phase.

In some cases, follow-up surgery is needed.

TED can cause muscles and fatty tissue behind your eye to swell. This can push your eye out of position.

In some cases, your eyelid is no longer able to cover the whole eye. When your eyelid can’t close all the way, the exposed part of your eye becomes very irritated.

This surgery adjusts the position of your eyelid.

Recovery

This surgery is done under general anesthesia.

Eyelid surgery is delayed until TED is stable, however. This means that if other surgeries are needed, those are done first.

Your eye needs to be back in proper position before eyelid retraction can be done.

You’ll likely be back to your normal routine in 1 or 2 weeks after eyelid retraction surgery.

Side effects

It’s normal for your eyes to be red and sensitive for a few days. There may be some bruising or swelling as well. Your eyelids may be red for longer but will improve in the weeks to come.

Cost

As with the other surgeries, many factors will influence the price. Your insurance is likely to cover the cost of this surgery when it’s performed as part of treatment for TED.

Outlook

Advances in this surgery are making it less invasive, with better results.

Having your eyelid back in the proper position relieves irritation of the eye. It can also help you feel and look more like your before-TED self.

As part of thyroid eye disease treatment, three surgeries that may be done. They are:

  • orbital decompression
  • strabismus (eye muscle) surgery
  • surgery to address eyelid retraction

Not everyone with TED will need surgery. You and your healthcare team can work together to decide the best treatment choices for you.

There have been advances in how the surgeries are performed to ensure the best outcomes.