Long Road Leads to Bright Future

August 19, 2014

16-year-old endures tough eye surgeries with grace and maturity.

Dory Pearlstone spent her freshman year spring break in the dark, sitting quietly, with her right eye stitched shut. One year later she spent her 2014 spring break on a mission trip, bringing light to tornado victims in Washington, Ill.

The active 16-year-old lives with her parents, Gregg and Nikki Pearlstone, in Chesterfield, Mo. She plays tennis and lacrosse, and loves art, photography and interior design. You could never tell what she has gone through to look and feel so vibrant.

When she was 11 years old, Dory lost weight, couldn’t sleep or concentrate and was constantly sick. She eventually was diagnosed and treated for Graves disease, an autoimmune disorder that leads to an overactive thyroid gland (hyperthyroidism).

Although Dory felt better, the hyperthyroidism caused her right eye socket to harden and her eye to bulge. When she was 14 years old, she was referred to Steven Couch, MD, Washington University oculofacial plastic surgeon at Barnes-Jewish West County Hospital. “That was the best thing that could have happened to her,” says her mom, Nikki Pearlstone.

Dr. Couch says thyroid eye disease occasionally occurs in patients with thyroid abnormalities.

Symptoms range from mild irritation, redness and dryness, to severe tearing, double vision and vision loss. Eye socket inflammation can cause the eye socket to protrude and the eyes to become more prominent. There also can be inflammation of the eyelids, causing a “staring appearance.”

“Bulging eyes from thyroid eye disease are common and typically occur because of inflammation and enlargement of the orbital fat and/or extraoccular muscles,” Dr. Couch says. “Besides cosmetic deformities caused by ‘buggy’ eyes, it can limit the eyelids closing and cause dryness. Rarely, eye bulging can lead to optic nerve damage from compression or stretching, which Dory luckily never experienced.”

The disease cycle takes one to two years, and it has an initial progressive phase, then it plateaus and becomes dormant. “Ideally, surgery is not performed until the disease process has stopped causing changes in eye position and has entered the nonactive phase,” Dr. Couch says. “Dory was monitored closely during the active phase of her disease to ensure she didn’t develop visual damage and to watch her go into the nonactive phase.”

Non-surgical treatment of thyroid eye disease includes artificial tears, lubricating eye ointment, steroids, radiation therapy and chemotherapy.

Surgical options include eye socket decompression surgery, strabismus surgery and eyelid surgery. Decompression surgery involves removing bony eye socket support to allow the eye socket tissues to expand. Strabismus surgery realigns the eyes by calculated repositioning of the eye muscles.

Dory had decompression surgery on her right eye in March 2013, which meant general anesthesia and a
one-night stay at Barnes-Jewish West County Hospital. Recovery required a week of Dory sitting quietly in a dark room.

“The orbital decompression surgery involves making incisions around the eye to gain access to the bones surrounding the eye and orbital soft tissues,” Dr. Couch says. “We surgically remove segments of these bones to allow the orbital tissues to expand and allow the eye to settle back in the skull.”

In June 2013, Dory needed a second surgery on her left eyelid to help with closure and to repair asymmetry. “She was unique in that most patients require surgical lowering of the eyelid to create the symmetry, but she needed one of her eyelids elevated to improve her vision and create symmetry,” Dr. Couch says.

This outpatient surgery was done under mild sedation while Dory was awake. Patients must be awake to allow for precise tightening of the eyelids to best create symmetry, Dr. Couch says.

“Dr. Couch has always been super honest with me,” Dory says. “Other doctors would sugar-coat things, but he is honest and talks to me, not just my parents. He’s a person first, then a doctor.”

Thyroid eye disease rarely recurs, but Dory will continue see Dr. Couch annually for a few more years. “I’m glad it’s over,” Nikki Pearlstone says. “It was a long, hard ordeal.”

“The Pearlstones are an incredible family,” Dr. Couch says. “I hope they felt like I was not only a surgeon, but a supportive consultant for them.”

The Pearlstones say Dr. Couch was definitely supportive. “He is caring and spends time,” Nikki Pearlstone says. “He talks to Dory like she’s a grown-up, but he also is sensitive to what she’s going through. He is fabulous with mom and dad. I can’t stress enough how remarkable Dr. Couch is with his bedside manner.”

Dr. Couch is equally impressed with the Pearlstones. “Dory suffered from a physically and psychologically devastating disease that many adults struggle with,” Dr. Couch says. “She approached her disease with maturity and elegance. Her journey through tough surgeries brought her to where she is now — a delightful, beautiful and confident young lady.”

To schedule an appointment with Dr. Couch, call 314.542.WEST (9378) or 1.800.392.0936.




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