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Thyroid Problems can Cause Uneven Eyes Diagnosis and Eye Surgery Important Before Cosmetic Surgery

My eyes have started to become uneven. Asa woman, it really affects my selfconfidence. I don't know if it's because of a poor botoxor it is because of the M.S. I'm willing to do whatever it takes to correct it. I readthe other article about the same issue; I thought my picture would explain more. Thank you for your question! You stated in your question that your eyesare becoming more uneven and you submitted a single photo. You mentioned that you haveMS and of course, you're looking for some kind of guidance.

Well, when I look at your photo, it appearsto me is that your right eye appears to be more prominent and that it is becoming a littlewider compared to the left eye. Now, when I see a photo like this, my concern is whetheror not you have something called thyroidrelated immune orbitopathy otherwise referred to asGrave's disease. I'm a board certified cosmetic surgeon,background training in ophthalmology or eye surgery plus oculoplastic surgery of the eyelid,orbits and lacrimal system and thyroid eye disease is something that we treat a lot.What this has to do is with an antibody, the fact that you have MS which falls in the autoimmunecategory, there is some possibility that you

may be manifesting another immune relatedissue. So I think that before you consider any kindof cosmetic procedures that you see first your medical as well as an ophthalmologistand even an endocrinologist to determine what is going on in your thyroid in any additionto any ophthalmic, things that are based on your eyes and the physiology. You may needsome imaging studies. But I would say you cannot pursue any cosmetic procedure giventhat there is this shift and change in your appearance. Again, the thing I can't sayis what degree of this change because you submitted a single photo. If you submitteda photo of you 5 years ago, a year ago and

this photo and there was a clear change andit makes more sense. But the fact that your eyes, there's a real change in the eyesthat's not typical, agerelated changes that we deal with so commonly, it's importantto get the medical workup first. We've treated a lot of thyroid eye diseaseand we've been able to help people in their inflammatory stage and then do definitivesurgery to help with issues related to eyelid retraction where the eyes are too open oreven do surgery behind the eye to get the eyeball to push inward. But again, this isgetting ahead of ourselves. It's more important that you get yourself properly diagnosed andget proper medical management before you do

something surgically. When it comes to thyroideye disease, we typically wait 6 months to a year after stability of the eye changesbefore we do any kind of surgery. So again, meet with your . Meet withan ophthalmologist, endocrinologist. Get some medical opinions before you pursue any cosmeticimprovement. So I hope that was helpful, I wish you thebest of luck and thank your question!.

How Thyroid Eye DiseaseGraves Disease Affects Eye and Eyelid Position

Is this ptosis and can it be curedé I am 22 years old and noticed a recent changeto my eyes where one looks significantly larger than the other. The right eyelid has dropped,and the other seems to give off a 'staring' and bulgy appearance. It's only become noticeablethisbad over the last few weeks. I went to the and was diagnosed with thyroid issues.I asked if this could be related, but she didn't give me any info. I am now on medicationand changed my diet completely. Will this help my eyesé What can I doé Thank you for your question!

You're 22 years old and you described verywell in detail with this one photo that you submitted how one is drooping and the otheris starting to bulging and staring. And that you have seen your and you were diagnosedwith thyroid issues and you are on medication. So I think that what you're going to belearning about and what this appears to be a situation called thyroidrelated immuneorbitopathy. Just to give you some background, I'm a board certified cosmetic surgeon butwith original training in eye surgery followed by training in oculoplastic surgery whichis surgery of the eyelids or the lacrimal system. And we specialize in thyroidrelatedeye disease.

So the term that is typically used in ourfield is thyroidrelated immune orbitopathy or TRIO. Another term that is more commonlyused is Graves' disease. What this disease is caused by an autoimmune response that theseantibodies that affect both the thyroid and the soft tissue of the eyes. A lot of peoplebelieve that the thyroid is affected by either by creating too much thyroid hormone calledhyperthyroid. In this disease, you can have high thyroid, low thyroid or hypothyroid orit can be normal thyroid or euthyroid. But there's often a misunderstanding that there'sa direct relationship between the thyroid hormone and the changes in the eyes. It'snot the case. The thyroid and the eyes are

affected by the antibodies and what's happeningis, your endocrinologist will manage you with either medication or may be even somethingcalled radioactive iodine to reduce the thyroid depending on what happens on your thyroidhormones. The eye changes will occur regardless, even if there has been some studies that haveshown that when the thyroid level is very high, the eye changes are worse. But a personcan have very well controlled thyroid but their eye changes can go on for years. In general, the understanding is that mostthyroid related immune disease is divided in to two stages: one is called the inflammatorystage and the other is called the fibrotic

stage. The inflammatory stage is the stageyou're in right now where there are continuous changes in the eye shape and the eye may pushforward, the eye may become very red, the eyes may retract and staring appearance willoccur. But it's a time of variability. And there are a lot of different options of howto manage depending on how the eyes are affected. Management options include nothing or observation,the use of steroids as well as the use of radiation and this will be determined by youand your s as things develop. When we talk about surgical options, we waitfor the stage called the fibrotic stage. The one exception of course is if the inflammatorystage occurs. The inflammatory stage is it

affects the muscles of the eyes as well asthe fat around the eyes. It also affects the eyelids. And that's why the eyes can evennot bulge out but the eyes can open and become very retracted. During this inflammatory stage,like I said, there's continuous changes. There's a time where the disease finallyburns out and it becomes what's called the fibrotic stage. And that's the stage whenthe appearance becomes more stable. Now the time frame is, this inflammatory stage canlast up to 5 years but in typical al experience, it will last up to somewhere twoyears. The way to determine stability is by doingmeasurements by the relative position of the

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