When Linda Williams walked into the clinic for her first appointment with Andrew Harrison, M.D., she had crossed, protruding eyes, and her eyelids couldn’t close completely. She was miserable and in desperate need of help.
A couple of years earlier, after the birth of her second child,Williams had been diagnosed with Graves’ disease, a hyperthyroid disorder associated with anxiety, high energy, sudden weight loss, and difficulty sleeping. It eventually affects the eyes in about half of the patients with the disease, but only 5 percent of those patients require treatment for their symptoms.Williams was one of them.
“Linda had the classic findings of thyroid eye disease when I first saw her,” says Harrison, an assistant professor of ophthalmology and otolaryngology and director of ophthalmic plastic and reconstructive surgery. “Besides protruding eyes, or proptosis, she had crossed eyes, or restrictive strabismus, because the swelling in her eye muscles prevented the normal movement of her eyes. She also had problems with eyelid retraction, and her eyelids were spread open wider than normal. This is a troublesome combination.”
Williams’s symptoms were being treated with oral steroids, which were not only ineffective but resulted in excessive weight gain. The first thing Harrison did was to gradually decrease her dosage of steroids; he then began injecting localized steroids near her eyes.
It soon became apparent that Williams would need surgery to correct her protruding eyes. Harrison and George Goding Jr., M.D., of the Department of Otolaryngology told Williams about orbital decompression surgery. The surgery is extremely delicate and requires the collaborative expertise of an ophthalmologist to remove bone from behind the eyes and an otolaryngologist to remove bone from between the eyes and the sinuses. These steps make more room for the eyes to settle back into their sockets.
In spite of her symptoms,Williams was initially reluctant to have eye surgery. “I think Dr. Harrison’s confidence is what persuaded me to go ahead with it,” she says. “He didn’t try to talk me into it, but he told me about each procedure I needed and explained how it would help. I knew I could trust him when he told me I wasn’t the worst case he had seen.”
The orbital decompression surgery was performed first. “Not until I woke up after surgery did I realize how much pain I had been in,” says Linda. “Before the surgery I had this sensation of twisting and grinding behind my eyes, and that was gone.”
Next, in order to correct her eye misalignment, Linda underwent strabismus surgery by Stephen Christiansen, M.D. A few months later, Harrison performed bilateral eyelid surgery, lowering Linda’s upper eyelids so that her eyes would close properly.
The 37-year-old mother from Coon Rapids, Minnesota, looks back on her days before surgery with some amazement.
“Before I had surgery I wasn’t out in public very often,” she says. “Because my eyes looked so unusual, people stared at me, especially children. I had double vision because of my crossed eyes. Before eyelid surgery I had to sleep with an eye mask because my eyes wouldn’t close. In my Graves’ disease support group, I heard from women who would tape cotton balls over their eyes before going to sleep. It’s a terrible thing not to be able to close your eyes completely.”
“It’s also a pleasure to work with Dr. Goding from otolaryngology, with Dr. Christiansen for the strabismus treatment, and with the endocrinologist who is managing Linda’s Graves’ disease,” says Harrison. “Cases like Linda’s make it imperative that we work as a team so that she gets all the treatment she needs.”
After her surgeries,Williams feels like her life is under control again. “I don’t know what would have happened to me if I hadn’t had those surgeries,” she says. “I didn’t feel right and I didn’t feel like I could care for anyone, and I’m the mother of two little boys with special needs.
“Having doctors who work together and who look at the whole picture has been so helpful to me,” says Williams. “My doctors at the University make me feel like family.”