Cosmetic Surgery for Thyroid-Associated Orbitopathy

Ophthalmologists generally consider Thyroid Associated Orbitopathy (TAO) to be a self-limiting periocular autoimmune condition often resulting in diplopia and which can potentially threaten vision through corneal exposure or optic nerve compression. The inflammation follows Rundle’s curve and will usually resolve by about 18 months, marking the end of the disease process for the patient. This stands in some contrast with patients’ views. For them, TAO is often primarily an aesthetic disease with disfigurement leading to loss of a sense of self and resulting in social isolation. Studies show that less than 5% of patients consider themselves “cured” when the doctor feels the disease has run its course, and there is a significant increased risk of suicide associated with TAO. Though both views of this disease are accurate, it points to the importance of aesthetic interventions in the management of TAO—an area which has previously been neglected by eye doctors who have been trained primarily to preserve vision. In this chapter we explore the ways in which TAO patients can now be helped by improving their appearance. This can be done medically, surgically and with non-surgical injectables.