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Focus on Steven Couch, MD

Steven Couch, MD, is an assistant professor of ophthalmology and visual sciences. His areas of interest include thyroid eye disease, ocular oncology and eyelid/orbital tumors, orbital inflammation, cosmetic eyelid and facial surgery, eyelid malpositions, post-traumatic deformities and ophthalmic reconstructive surgery.

Dr. Couch sees patients at:

The Eye Center in the Center for Advanced Medicine, 4921 Parkview Place, 12th floor, Suite C, St. Louis, MO, 63110

Barnes-Jewish West County Hospital, Medical Building Two,10 Barnes West Drive, Suite 201, Creve Coeur, MO 63141

FOR AN APPOINTMENT, PLEASE CALL 314-362-3937


What happened in the course of schooling to influence you to choose you specialty?

Because I enjoyed being in the operating room, in addition to being face-to-face with patients during medical school, I knew I wanted a specialty that allowed a presence in both areas. During my ophthalmology residency, I enjoyed the incredible variety of patients and cases treated by the ophthalmologic plastic surgery division. It was the microsurgical and precision-based surgery that led me to choose ophthalmic plastic surgery as my career.

What brought you to Washington University?

After my ophthalmology residency at Mayo Clinic in Rochester, Minnesota, I interviewed at many of the 17 fellowships in the country that were approved by the American Society of Ophthalmic Plastic and Reconstructive Surgeons. The training with Drs. John Holds and Philip Custer here in St. Louis seemed like the best fit for what I was hoping to accomplish in my career.

My fellowship was a tremendous experience clinically and surgically. I could not have had better mentors and friends than I have with Drs. Holds and Custer. I was lucky enough to be asked to stay on as faculty at Washington University and graciously accepted the position without question.

Which aspect of your practice is most interesting?

I enjoy utilizing and developing newer treatment options for cosmetic and functional problems of the eyelids. We now have the ability to use smaller incisions – providing more cosmetically oriented outcome.

While my practice is significantly weighted towards surgery, I also spend a great deal of time taking care of patients in the office treating patients with medical conditions.

The most interesting medical aspect of my practice is the application of newer developments for the nonsurgical treatments of ophthalmic conditions. For example, there is much research on the nonsurgical management of thyroid eye disease (Graves’opthamolopathy). I’m very excited about the possibility of treating patients who are in the active phase of ophthalmopathy and hopefully preventing or helping lessen complications from the disease.

What is thyroid eye disease?

It is an autoimmune condition that occasionally occurs in patients with thyroid abnormalities. While only a small percentage of patients with thyroid dysfunction develop thyroid eye disease (TED), most patients with TED have overactive thyroids. It is rare, but it can appear in patients with underactive or even normal thyroid functions.

The main problems around the eye include inflammatory infiltration of the orbit – which causes the eye socket to protrude and the eyes to become more prominent. TED can also trigger inflammation of the muscles around the eyes– resulting in misalignment and double vision. In addition, there can be inflammation of the eyelids, causing the retraction or the staring appearance of the eyes. The lower eyelid becomes lower and the upper eyelids become higher, allowing the eyelid aperture to become more open.

The disease generally traverses through a fairly classic pattern. There is an initial inflammatory phase, then it plateaus and becomes quiet – this cycle can take between one and two years. Patients who smoke are significantly worse than those who do not smoke. Quitting smoking is the only modifiable risk factor for the condition – besides normalizing thyroid functions if they are abnormal.

Non-surgical treatments can include oral or intravenous steroids and radiation therapy.
Surgical treatments consist of orbital decompression surgery which creates more room in the eye socket. We can also realign the eyes with strabismus surgery. A third surgical option includes creating a normal aperture for the shape and size of the eyelids.

Our hope is that eventually we can lessen the active phase of the disease through medical treatments including chemotherapy and therefore lessen the complications of the disease.

Where are you from?

I grew up in a small country town just north of Kansas City, Missouri, and went to Platte County High School. My wife grew up in Weston, MO, which is a little further north and a little bit smaller.

As early as middle school, I knew I wanted to be a physician. My mother was a homemaker and my father was a police officer, and I am the first doctor in my family.

My biggest mentor throughout my training was William Gilbirds, MD, a family medicine doctor in Kansas City. He guided me through many aspects of my life both professionally and personally. He helped me get into the University of Missouri-Kansas City (UMKC) – six-year combined undergraduate and medical school program.

I met my wife during my first year at UMKC. We got married towards the end of medical school and both did our residency at the Mayo Clinic. St. Louis was a good fit for fellowship training, and that’s how we ended up here. My wife is an urgent care physician at Mercy Clinic, and we have a sweet little girl.

Is there a particular award or achievement that is most gratifying?

My Eagle Scout Award is my most gratifying achievement. My father was an Eagle Scout and I worked really hard towards getting that award. I’m very proud of that achievement.

In addition, I was a Heed Ophthalmic Fellowship recipient during my last year of my fellowship. It is a rigorous selection process and a very big honor within ophthalmology. It allowed me to participate in more clinical research during my last year of fellowship.

Is there any research you are involved in right now?

I’m involved in research on the effects of botulinum toxin (Botox) on facial spasm syndromes. In addition, I’m also doing research on the outcomes of orbital tumors and orbital malignancies.
What is the best advice you’ve ever received?

My parents were very good role models. They stressed the importance of hard work in everything they did.

If you weren’t a doctor what would you like to be doing?

I considered becoming a dentist – I think that’s a great career. If I wasn’t a doctor, I would still be doing something in the patient care industry.

On a personal level, I really enjoy the outdoors and think it would be fun to be a professional hunting guide.