• Graves' ophthalmopathy generally causes the eyelids to open more widely. 
• The front surface of the eyeball becomes exposed beyond the eyelids and causes discomfort and excessive tearing; exposure keratopathy.
• Surgically repositioning the eyelids can reduce the irritation. 
• If orbital decompression, eye muscle and eyelid surgery are required, the eyelid procedure is generally performed as the final procedure in the series.
• The upper eyelid retraction may  be worsened if the eye is unable to elevate normally (strabismus), and extra nerve impulses are sent simultaneously to the muscle which elevates the lid  and to the muscle struggling to elevate the eye itself; once the restriction is  treated (e.g. strabismus surgery), the degree of retraction often decreases.

• Graves' ophthalmopathy generally causes the eyelids to open more widely. 
• The front surface of the eyeball becomes exposed beyond the eyelids and causes discomfort and excessive tearing.

• Many different materials are available in order to help elevate the lower eyelids ranging from donated sclera to products like Alloderm, which elevates the eyelid from the inside.

• Dry eye and foreign body sensation are major considerations for performing such surgery.

• Celluvisc
• Refresh
• Refresh Plus
• Refresh PM

• Double vision usually occurs because the eyes are out of alignment. 
• Misalignment often is caused by one or more eye muscles that are too short or "tight" because of scar tissue from Graves' ophthalmopathy. 
• This scar tissue results from changes in the eye because of inflammation.

Prisms

• Prisms may be temporary (pasted on) or permanently ground into your lenses. However, prisms do not work for all people with double vision. Sometimes eye muscle surgery is a more effective treatment.

Eye Muscle Surgery

• The goal of eye muscle surgery is to achieve single vision when looking straight ahead and when reading. During eye muscle surgery the muscle is cut from its attachment to the eyeball and reattached further back. Usually eye muscle surgery does not require an overnight stay in the hospital. More than one operation is sometimes required.

• If the optic nerve is compromised, and vision is threatened as a result of Graves' disease, the term optic neuropathy may be applied.

Orbital Decompression Surgery

• In orbital decompression surgery the bone between the orbit (eye socket) and the sinuses (air spaces next to the orbit) is removed. 
• A successful procedure improves vision and provides room for the eye to slip back into the orbit's protection.
• There are possible complications of the surgery, however. 
• You may experience lip numbness for several months after the operation. 
• ouble vision may persist or it may develop anew after surgery

View Orbits following 2 -wall orbital decompression

• Orbital volume  and dimensions:  = 30 cc, 35(Height) x 45(Width) x 45 mm(medial wall depth), globe 25 x 25 mm
• Bones: (F)rontal, (M)axillary,(Z)ygomatic, (L)acrimal, (E)thmoid, (P)alatine, (S)phenoid