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treatments for proptosis other than decompression

Hello

I hope someone can help.
I have proptosis of 19mm and 20mm i.e. borderline for orbital decompression but MRI shows no evidence of TED. I have hashimotos but not graves, my TSH has never really been out of range for as long as I have been having it tested (but as i went years without diagnosis i could possibly have been hyuper at some stage).

I have had high myopia since teenage years and prior to that had fairly large eyes naturally (but not proptosis). I have had an MRI scan which dosn't exhibit the tell tale 'coke bottle' sign of TED...therefore I have had no definate diagnosis - some Dr's say thyroid has caused the problem, others just blame my myopia. I had no proptosis until early thirities and i am now late thirties.

In the private sector (I am UK based) the Dr's I have consulted with say orbital decompression is too risky on the myopic eye and since I am 'borderline' wont do it. The state Dr's are offering, palette spacer graft for the larger eye, mid face lift and fat transfer then possibly sealing the tear ducts. My eyes are very dry in the morning and outside sometimes but i wear contact lenses without problems and eyes are ok indoors usually. I am quite sensitive to light, eyes tire easily. The skin on the lower eyelids seems 'swollen' and I think it is because of pressure from the eye pushing from behind, ad the larger eye is worse. Eye white is apparent under my iris on the larger eye and sometimes on the other.

I would be very grateful for opinions on whether the palette graft / mid face lift / fat transfer would be a good option for someone in my position or would it be worthwhile to just go private for the orbital decompression? My myopia is -10.

Very many thanks for any advice/
6 Responses
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233488 tn?1310693103
MEDICAL PROFESSIONAL
you are welcome and good luck.
JCH MD
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Avatar universal
thank you very much for your help.
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233488 tn?1310693103
MEDICAL PROFESSIONAL
My final suggestion would be to consult at least 3 highly respected oculoplastic surgeons before deciding on a course of action. You can also use the search feature and archives and read a lot about orbital decompression.   Ask about a more minor procedure like "recessing the eyelid retractors.

JCH MD
Helpful - 0
Avatar universal
Thank you for your kind response.

Fat transferal has also been suggested as has palette graft. In the instance of borderline proptosis causing moderate dry eye / discomfort due to eyelid positioning and moderate cosmetic problems due to under eye hollows is it possible that fat transfer alone might help a little bit regarding the eye being over exposed?  I know it is usually intended for the cosmetic purposes only, but I wondered whether having a little more fat in the under eye area might reduce 'drag' on the lower eyelid and possibly give it better support.

Very grateful for any suggestions for treatment for proptosis deemed not quite severe enough for orbital decompression. Thank you so much.
Helpful - 0
233488 tn?1310693103
MEDICAL PROFESSIONAL
I do not think it likely that you will find a surgeon anxious to operate on you. The risks are considerable.

JCH MD
Helpful - 0
Avatar universal
sorry - there's a typo, above was meant to state that state doctors advised against decompression, while those in private sector viewed it as low risk and were willing to perform it - informing me decompression is sometimes carried out for very large eyes due to myopia alone.
Helpful - 0
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