The gift of sight

Former thyroid eye disease patient volunteers at Byers Eye Institute

Almost four years ago, Peggy Kixmoeller was diagnosed with thyroid eye disease (TED). This is an autoimmune disorder where the body mistakenly attacks healthy cells, specifically the thyroid gland and the tissues around the eye.

“TED is a complex and potentially disfiguring condition that can have significant effects on the appearance and function of the eye,” Andrea Kossler, MD, assistant professor of ophthalmology, said. “These patients are at risk of vision loss and when severe, patients may require steroids, radiation, or new targeted therapies, plus multiple surgical procedures to rehabilitate the eyes.”

Symptoms of TED include eye redness, pain, double vision, blurry vision, and swelling that can result in eye bulging, inability to close the eyes, and loss of vision. TED also affects patients emotionally, because it can change a patient’s appearance and impact quality of life.

Before coming to Stanford, Kixmoeller endured months of doctor’s appointments, eye drops, medications, and intravenous infusions while she continued to lose vision.

“I started to notice indoors I was losing my color vision, now swapped for shades of gray, and even outdoors I could only see the brightest colors,” Kixmoeller said.

With no improvement, her son Matt, daughter Sara, and daughter-in-law Wakana, recommended she get a second opinion at Stanford.


A look at Kixmoeller’s visual field tests before and after surgery

Visual field left eye

Visual field right eye

Before decompression

Visual field left eye

Visual field right eye

After decompression

Comprehensive diagnosis and therapy at Stanford

When Kixmoeller first came to the Byers Eye Institute at Stanford, she knew being Kossler’s patient would be different.

“During that first meeting, Matt and I spent two hours in Dr. Kossler’s office where I quickly came to see how kind and understanding she is,” Kixmoeller said. “She demonstrated a love for what she did and confidence about the plan going forward.”

Kossler is the director of the Ophthalmic Plastic, Reconstructive Surgery and Orbital Oncology Service at Stanford. She has over eight years of experience in treating patients with severe TED and is researching new, targeted therapies to treat and reverse the effects of TED. Kossler also co-directs the Thyroid Eye Disease Multi-Disciplinary Center at Stanford Hospital, where she works with a team that includes an endocrinologist, Chrysoula Dosiou, MD, MS, and a radiation oncologist, Susan Hiniker, MD. This trio and other members of the care team oversaw Kixmoeller’s journey at Stanford.

Kossler diagnosed Kixmoeller with severe active TED with compressive optic neuropathy. Her orbital swelling put pressure on her optic nerve resulting in vision loss. Kossler recommended urgent orbital decompression. Decompression surgery would remove the bone between her sinuses and eye cavity to create more space and relieve the compression on the nerve that controls her vision. Kixmoeller underwent orbital decompression surgery. She awoke the next morning and could see.


Before (2016)

 Kixmoeller’s eye were swollen, red, and painful when she first arrived at Stanford.

After (Now)

Almost four years later, Kossler and Kixmoeller remain friends after Kixmoeller’s recovery.


“I now have the gift of vision again that Dr. Kossler gave to me. She was both meticulous and caring in her work and exceeded my expectations on every level.

“I fought back tears when I realized that for the first time in ages I could see the eye chart and I could see colors,” Kixmoeller said. “I had been told by other ophthalmologists I would likely lose my vision, but at Stanford I regained my vision.”

After restoring vision with bilateral decompression surgery, she required eye muscle surgery to correct double vision and eyelid surgery to improve eye closure, comfort, and symmetry. Three years after being diagnosed with TED, she feels like herself again.

“I feel those years went by fast and I saw everything come full circle,” Kixmoeller said. “I can truly say this journey was worth it, because I now have the gift of vision again that Dr. Kossler gave to me. She was both meticulous and caring in her work and exceeded my expectations on every level.”

Out of gratitude for Kossler and her team, Kixmoeller decided to give back to Stanford. In 2018, she began volunteering at the Byers Eye Institute, where she can help those who don’t have their vision navigate the building.

“Patients like Peggy and her family, are the reasons I love my job,” Kossler said. “Seeing her enjoying life and volunteering at the Byers Eye Institute each week always brings a smile to my face. She is an inspiration to doctors and patients alike.”

“I have a whole new perspective on life” Kixmoeller said. “Now that I have my vision back, I get to enjoy the things I did before like sewing, running, or most importantly spending time with family. I am forever grateful to Dr. Kossler and her team for changing my life.”



Kathryn Sill is a web and communications specialist for the Byers Eye Institute in the Department of Ophthalmology, at Stanford University School of Medicine. Email her at