Thyroid Eye Disease in the Stable or Chronic Phase: Cosmetic and Reconstructive Treatment Options

Patients with thyroid eye disease (TED) who have entered the stable or chronic phase often experience fibrotic changes in the orbital tissues. At this stage, the disease is no longer actively progressing, making it an ideal time to consider reconstructive and cosmetic surgical interventions. These procedures aim not only to improve functional issues such as vision impairment and eye movement but also to restore a more natural facial appearance. Below are key surgical approaches commonly used during this phase.

Orbital Decompression Surgery

One of the most effective treatments for correcting proptosis (bulging eyes) is orbital decompression surgery. This procedure involves removing parts of the orbital walls or resecting retrobulbar and periorbital fat to create more space within the eye socket. As a result, the eyeball can retract into a more anatomically normal position. This not only improves aesthetics but can also relieve pressure-related symptoms such as discomfort and optic nerve compression.

Extraocular Muscle Surgery

Diplopia (double vision) is a common issue in chronic TED due to scarring and fibrosis of the extraocular muscles. To correct misalignment, surgeons may perform muscle recession or weakening procedures. This typically involves detaching and reattaching the affected muscles in a new position to restore proper ocular alignment and binocular vision. The timing of this surgery is crucial—typically performed after the disease has been stable for at least six months.

Correction of Eyelid Retraction

Upper and lower eyelid retraction is another hallmark of long-standing thyroid eye disease. It leads to an overly wide palpebral fissure, giving patients a perpetually startled look. Surgical correction involves lengthening the retracted eyelid using techniques such as spacer grafts from hard palate mucosa, processed donor tissue, or autologous fascia. These methods help achieve a more natural eyelid position and improve both appearance and corneal protection.

Revision of Abnormal Double Eyelids

Many patients with TED develop abnormally high or multiple upper eyelid creases due to swelling and tissue changes. These aesthetic irregularities can be corrected through revision blepharoplasty. Techniques include the use of fat-fascial flaps, fat grafting, or transposition of local tissues to recreate a natural-looking double eyelid fold. Autologous fat transfer is particularly beneficial, offering volume restoration while minimizing the risk of rejection.

In summary, reconstructive surgery during the stable phase of thyroid eye disease plays a vital role in restoring both function and facial harmony. A personalized, multi-stage approach—often combining decompression, muscle, and eyelid surgeries—delivers optimal outcomes. Patients considering these procedures should consult with an experienced oculoplastic surgeon to develop a tailored treatment plan based on individual anatomy and aesthetic goals.