Monday, December 29, 2008

Strabismus - Eye Muscle Realignment Surgery

Patrick made it through his eye muscle realignment surgery with flying colors. The surgery was much less intrusive than the orbital decompression surgery, and his recovery time was significantly less than that of his prior surgery.

After the orbital decompression surgery, Patrick's eye muscles became cross-eyed. This muscle adjustment caused double-vision for Patrick at nearly all times. The muscle realignment surgery was scheduled to correct this problem after Patrick had healed significantly from his first surgery.


Patrick pre-surgery

The surgery lasted approximately two hours, and Dr. Cahill only worked on his left eye. He loosened some of the muscles around Patrick's eye so that they could adjust appropriately. A local anasthetic was used rather than putting him completely under as they had in his orbital decompression.

We were able to visit him within an hour of the conclusion of the surgery. He was able to walk, talk, and laugh. His pain was significantly less than that of the orbital decompression.


Patrick immediately after surgery

He was released from the hospital approximately an hour and one-half to two hours after the surgery had been completed.

No comments:

Photo Prior to Diagnosis

Photo Prior to Diagnosis
Patrick's appearance prior to the onset of Graves' disease

Initial Diagnosis and Development

Patrick was diagnosed with Graves' Disease in December of 2005. He recognized that something was wrong when his eyes began to alter and he felt constant fatigue. After a misdiagnosis of mononucleosis (mono), Patrick’s doctor finally concluded that Patrick had Graves’ disease along with Thyroid Eye Disease (TED). He could not begin to work on eyes until his thyroid had been successfully managed.

The first step in the treatment of his Graves' Disease was to stabilize the thyroid. Patrick attempted to do this with medication only. However, this method can be very inconsistent because the thyroid is still present within the body and can continue to produce erratic levels of hormone. To regulate his thyroid, his doctors determined that it would be best to undergo radioiodine treatment. This involves taking a radioiodine pill that would kill his thyroid. By killing his thyroid, his doctors could more easily ensure proper levels of hormones within his body.

While Patrick was incredibly hesitant to undergo the radioiodine treatment, he finally consented to the treatment after realizing the benefits of the procedure and exhausting all other options other than surgery to remove the thyroid. His major hesitation stemmed from the possibility that the treatment could cause blindness. However, this side effect, while possible, is rare.

Patrick took the radioiodine pill and was required to avoid contact with others for three days. After the radioiodine treatment, Patrick and his team of doctors worked to regulate the levels of hormones within his body. Regulation of the thyroid hormones can allow the eyes to return to normal health and appearance for a small percentage of patients. However, this did not result from his procedure. He had to remain stable for approximately 1.5-2 years before they could begin work on his Thyroid Eye Disease.

His team of doctors outlined the procedures required to repair his eyes. It was determined that he would have to undergo 3 surgeries: orbital decompression, muscle realignment, and plastic.

The first of the surgeries, orbital decompression, involves removing bones around the eyes and in the sinus cavity to provide more space for the eyes. The Graves' disease increased the size of the fatty tissue and muscles behind the eyes. Removing this build-up is dangerous and can result in blindness. Therefore, the best option becomes providing more space for the eyes to fill and reduce the pressure caused by the disease. It also allows the eyes to "fall back" into his head, reducing the protrusion.

The muscle realignment surgery would attach the muscles around the eyes to new locations so that he could see effectively. The increase in size of fatty tissue and muscles as well as the removal of bone changes the structure of the eyes. This surgery's purpose is to ensure that his eyes could function properly.

The plastic surgery would help to improve the appearance of the eyes.


Day of the Surgery

Patrick had orbital decompression surgery performed on both eyes. The procedure lasted approximately 7 hours, during which time he was under anasthesia. He came out of the anasthesia 1 hour after the surgery had been completed, and he remained in the hospital overnight. According to the doctors' report, the surgery went incredibly well. They removed bone structure from the sides of both of his eyes as well as the top of the nose in the sinus cavity. His eyes immediately closed completely, something that had not happened to him in nearly two years.

The first eye they operated on was Patrick's right eye. They were able to create an artificial eyelid during this portion of the surgery, eliminating parts of an anticipated future surgery. By the time they began work on Patrick's left eye, he had swollen too much for them to perform this work safely. When you view the pictures, it is clear that his right eye is more bruised and swollen, an indication of the more extensive work that occurred on this eye. However, his left eye sags lower than his right eye because they were unable to perform this portion of the surgery on this eye.

The tape below the eyes was placed to help elevate them and prevent sagging. He has noticeable sutures on the outside corners of his eyes where the doctors removed bone. He also has a sore on his nose where they entered to remove the bone of his sinus cavity.

Overall, the procedure was incredibly successful.

Pre-Orbital Decompression Surgery Photo

Pre-Orbital Decompression Surgery Photo
2 hours prior to orbital decompression surgery

Pre-Orbital Decompression Surgery Photo

Pre-Orbital Decompression Surgery Photo
2 hours prior to orbital decompression surgery - Profile

Day 1 After the Surgery

When the doctors opened Patrick's eyes on the first day, he had double-vision, an expected result of the surgery. However, there was no blindness or color-blindness. He could recognize objects, including the doctors' faces and two finger-counts. He was also able to read the clock with complete accuracy.

His nasal passages were full of remnants of the surgery, including dried blood clots and mucus. His eyes were weepy, increased by the medicated salve. He slept the majority of the day, and it hurt to eat food at this point.

1 Day After Orbital Decompression Surgery

1 Day After Orbital Decompression Surgery
1 Day After Orbital Decompression Surgery

1 Day After Orbital Decompression Surgery - Profile

1 Day After Orbital Decompression Surgery - Profile
1 Day After Orbital Decompression Surgery - Profile

Day 2 After the Surgery

On the second day after the surgery, Patrick was able to open his eyes slightly more. His left eye sagged significantly more than his right. The swelling around his eyes and cheeks increased dramatically. The double-vision continued. His nasal passages were also full of remnants of the surgery, including dried blood clots and mucus.

He was finally able to eat without intense pain. He also remained awake longer throughout the day than he had on the previous day. His eyes continued to weep.

2 Days After Orbital Decompression Surgery

2 Days After Orbital Decompression Surgery
2 Days After Orbital Decompression Surgery

2 Days After Orbital Decompression Surgery - Profile

2 Days After Orbital Decompression Surgery - Profile
2 Days After Orbital Decompression Surgery - Profile

Day 3 After the Surgery

Patrick had significant improvement on this day. His eyes were opening more with his left eye still sagging. His appetite had returned to normal, and the remnants of the surgery in his nasal passages had decreased significantly.

His eyes were still seeping, particulary after he put on the medicated salve. They were still swollen, and the bruises were beginning to visibly heal.

3 Days After Orbital Decompression Surgery

3 Days After Orbital Decompression Surgery
3 Days After Orbital Decompression Surgery

3 Days After Orbital Decompression Surgery - Profile

3 Days After Orbital Decompression Surgery - Profile
3 Days After Orbital Decompression Surgery - Profile

Day 4 After the Surgery

Patrick's eye swelling was visibly reduced. His bruising continued to heal, and he was able to open his eyes much more. The double-vision continued. He anticipates that this will be eliminated when they remove the stitches from his eyes 10 days after the surgery. However, in order to alleviate the difficulty with the double-vision, he began to wear an eye patch over his left-eye. This significantly improved his ability to see.

4 Days After Orbital Decompression Surgery

4 Days After Orbital Decompression Surgery
4 Days After Orbital Decompression Surgery

4 Days After Orbital Decompression Surgery - Profile

4 Days After Orbital Decompression Surgery - Profile
4 Days After Orbital Decompression Surgery - Profile