Eye Muscle Surgery for Thyroid Eye Disease

Reviewed by: HU Medical Review Board | Last reviewed: September 2023

The progressive damage caused by thyroid eye disease (TED) can vary from person to person. TED affects the tissues behind and around the eyes. The damage caused by TED occurs in phases, with active and inactive phases.1,2

While damage and loss of function is common in TED, there are treatments available to help. Surgery can correct the damage that TED causes, such as scarring to the muscles and tissues around the eye. However, surgery is typically not performed in the active phase because inflammation and damage may still occur.3

Once TED reaches the inactive phase, a TED specialist will decide if surgery is needed. Multiple surgeries are usually needed to correct the damage caused by TED. Eye muscle surgery is a surgery that might be needed.3

What is strabismus?

Strabismus (struh-biz-miss) is misaligned or "crossed" eyes resulting from problems with the muscles that attach to the eyes.1

Strabismus in TED results from inflammation and eventual hardening (fibrosis) of the eye muscles. This causes swelling and thickening of the eye muscles. Fibrosis of these muscles can restrict eye movement. When the eyes cannot move freely, double vision (diplopia, dip-low-pee-uh) can occur.4

What is strabismus surgery?

Surgery to repair the eye muscles and realign the eyes might be needed for some people with TED. Strabismus surgery is often done under general anesthesia. General anesthesia means you are fully asleep during the procedure. However, your TED specialist may decide that fully numbing your eyes and face is a better option.5

This procedure is performed by an eye surgeon and involves detaching, tightening, and reattaching the eye muscles. Your TED specialist may decide the muscles need to be weakened (recession) or tightened (resection).3,5,6

How does this surgery help in TED?

The primary goal of strabismus surgery is to realign the eyes. Other goals include:4

  • Decrease or stop double vision
  • Decrease eye strain from eye muscle problems
  • Restore or improve peripheral vision
  • Eliminate or improve abnormal head posture that can occur as people compensate for abnormal vision
  • Improve the ability to maintain eye contact with others

The mental health benefits of eye muscle repair should not be minimized. Realigning the eyes can improve the cosmetic appearance of the face, which could be a main reason for some people to consider eye muscle repair.4

Eye muscle repair can affect your eyelid position. Because of this, surgery is performed before eyelid repair surgery.3

What are the possible side effects of eye muscle surgery?

Like all surgeries, eye muscle surgery has possible side effects, including:7

  • Double vision, which can be temporary but may require more surgery
  • Infection
  • Allergic reaction to the surgical materials
  • Scarring
  • Bruising
  • Retracted (pulled back) eyelids

These are not all the possible side effects of strabismus surgery. Talk to your doctor about what to expect with eye muscle surgery. You also should call your doctor if you have any changes that concern you after eye muscle surgery.

Other things to know

It is normal to have some redness and irritation of your eyes after surgery. Your eyes will likely be sore, especially when they move. Muscle soreness usually improves within a few days, depending on the type of surgery performed. Redness and irritation of the eye can last several weeks or even months.5-7

Your TED specialist surgeon will apply antibiotic eye drops after the surgery. In some cases, you will have to use these drops for a period of time after surgery. Talk to your surgeon about specific aftercare instructions.5

Have you had eye muscle surgery for thyroid eye disease? If so, please share your experience and connect with other community members in this forum.

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