Thyroid Eye Disease

What is Thyroid Eye Disease;

A systemic disease is one that affects many organs within the body. This may include the eyes. Thyroid Eye Disease (TED) is one such disease that causes an inflammatory response in the eyes and surrounding tissues.
TED is an autoimmune reaction that causes swelling of the eye tissues – the eye muscles, the lacrimal glands, the eyelids and fat tissue.
In some cases, the symptoms are so pronounced that the eyes can no longer move in the straight line with each other.

In addition to the eyes, about 90% of sufferers also have a disease that affects the thyroid gland. This is known as Graves’ disease. This tends to happen when the thyroid is overactive – known as hyperthyroidism. But it can rarely cause underactive gland function (hypothyroidism). TED can also occur in people with a normally functioning thyroid.

Due to the complexity of the condition, those suffering from TED should have a treatment plan that will be served by both a specialist ophthalmologist and an endocrinologist (thyroid specialist).

Thyroid eye disease is often misdiagnosed initially. This is because some of the symptoms are very similar to other conditions, such as hay fever, allergies or conjunctivitis. Because TED can have a significant impact on the quality of life of a patient, expert treatment should be sought at an early stage to determine the problem.
Thyroid eye disease, along with other systemic eye diseases, is best diagnosed by a specialist service offered at our ophthalmology center.

Symptoms that may alert you to seek advice from an ophthalmologist who specializes in thyroid eye disease include:

  • Changes in the appearance of the eyes: Swelling or prolapse

  • Swelling: Both the upper and lower eyelids can be affected

  • Pain: Behind or in the eye. This may be more evident when looking down, up, or to the side

  • Dry or gritty eyes

  • Difficulty moving the eyes

  • Redness: In the eyes themselves and/or around the eyelids

  • New bags under the eyes

  • Photophobia: Intolerance to bright light

  • Blurred vision: Including double vision

  • Watery eyes

  • Headaches: As the swelling increases, this can cause pressure pain or a deep headache. It usually gets worse when you move your eyes

There are various treatments for Thyroid Eye Disease, ranging from drug therapy to surgery. The most suitable for your condition will depend on many factors and will be agreed through discussion with you and collaboration between your ophthalmologist and your endocrinologist.

TED follows a 2-phase disease course. The first is known as the active stage, where the symptoms will worsen, before they subside and entering stage 2, the most stable stage. Stage 1 usually lasts for 1-3 years (it lasts longer in those who smoke), after which the condition stabilizes. Early treatment is the key to reducing the severity of symptoms.

Treatment options include:

  • Gaining normal systemic thyroid hormone levels: Various drugs are used to regulate the production of thyroid hormones. Other options include radioactive iodine ablation or thyroidectomy.

  • Steroid therapy: To reduce inflammation and swelling of eye tissues. This can be done through oral steroid intake (such as prednisolone) or, if ineffective, intravenous steroid therapy.

  • Orbital radiotherapy: It is usually used in conjunction with steroid therapy, which involves targeting the tissue behind the eyeball with a controlled beam of radiation to reduce orbital pressure.

  • Surgical orbital decompression: If the swelling becomes too severe, it can cause pressure on the optic nerve. There are many different approaches to the procedure, all aimed at relieving pressure on the optic nerve and blood supply.

  • Treatment of eyelid retraction: This can be treated non-surgically (through steroid injections, fillers or Botox) or with surgery to relieve tension. One such treatment is blepharotomy. This includes a small incision made in the eyelid to help it lengthen and close properly.

  • Correction of strabismus: Strabismus can occur from swelling and tightness of the eye muscles. Generally it is treated with prismatic lenses. However, if these are not suitable or unsuccessful then strabismus surgery may be needed.

During both the acute and stable phases of Thyroid Eye Disease, it is essential to have regular assessments/treatments. Although it is rare for TED to cause permanent vision problems, if left untreated, this becomes more of a possibility.

There is no doubt that Thyroid Eye Disease can be a condition that affects the quality of life. Symptoms such as double vision, the development of ulcers around the eye if the eyelid cannot be closed properly and, in untreated and severe cases, compression of the optic nerve can cause loss of vision.

As well as being able to prescribe medication and/or performing any necessary surgeries, a specialist will advise on other aspects that have a direct impact on the severity and progression of the disease. These include:

  • Stopping smoking: Smokers are much more affected by TED than non-smokers. Not only are they more likely to suffer from the beginning, but the condition lasts longer, the symptoms are more pronounced and the risk of permanent vision damage is higher.

  • Other lifestyle modifications: Such as reducing your salt intake, sleeping in a place where your head is elevated, and using sunglasses.

  • Dry eye management: You may be prescribed eye drops or ointment to keep your eyes moist.

  • Pain relief: Either over-the-counter drugs or prescription analgetics.

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