Thyroid Eye Disease

There are many different names you might find for the autoimmune eye condition that is often seen with thyroid disease, including:

• Thyroid Eye Disease, sometimes abbreviated as TED
• Graves' Opthamolopathy
• Thyroid-associated orbitopathy (TAO)
• Grave's orbitopathy

One general sign of a thyroid problem is steady and unexpected weight loss, which is actually caused by a sudden increase in metabolism. A person may go months without realizing there is a problem with the thyroid because many of the patients suffering from an overactive thyroid will not feel unwell. Untreated, an overactive thyroid can go on to cause other problems, one of them being eye disease. This is just one example of why it is so important to treat any problems with the thyroid as soon as they are discovered.

Thyroid Eye Disease is an autoimmune eye condition that, while separate from thyroid disease, is often seen in conjunction with Graves' Disease. The condition, however, is seen in people with no other evidence of thyroid dysfunction, and occasionally in patients who have Hashimoto's Disease. Most thyroid patients, however, will not develop thyroid eye disease, and if so, only mildly so.

Causes of  thyroid eye disease

Most people with thyroid eye disease have or had or will subsequently develop an overactive thyroid gland. In 20% the thyroid eye disease develops in people who do not have an overactive thyroid at the time (may subsequently develop this years later). In 40% thyroid eye disease occurs whilst the thyroid is overactive and in 40% can occur years after the overactive thyroid has been treated successfully.

Overactivity of the thyroid gland is usually caused by an "autoimmune condition" This means that cells which normally protect the body from infection develop a "fault" and begin to recognise the thyroid gland as foreign material and attack it. This stimulates the thyroid gland to produce extra thyroid hormones. The attacking process may spill over to the cells behind the eye causing them to swell. It is not yet known why cells develop the fault that causes them to attack the thyroid gland or why only some patients with overactivity of the thyroid develop thyroid eye disease. Thyroid eye disease does appear to be more common in smokers.

Signs and Symptoms of Thyroid Eye Disease

Signs and symptoms include:

• Pain in the eyes, pain when looking up, down or sideways
• Dryness, itching, dry eyes, difficulty wearing contact lenses
• Inflammation and swelling of the eye, and its surrounding tissues
• Swelling in the orbital tissues which causes the eye to be pushed forward -- referred to as exophthalmos -- which can make Thyroid Eye Disease sufferers appear to have a wide-eyed or bulging stare.
• Bloodshot appearance to eyes
• Double vision (doctors call it diplopia)
• Impaired vision

Diagnosis

• The normal procedure for checking for eye disease is to do a complete eye test. The eye test will include procedures designed to assess the optic nerve, the cornea and the eyelid. Special attention is given to the movement of the eye and the position the eye rests in. It is a good idea to have the blood checked to see what level the thyroid hormones are at. Some doctors will order a CT scan or an ultrasound to get a better look at the swelling of the eye and the surrounding tissue.

Treatment

-Irritation and Redness of the eyes

Artificial tears (hypromellose drops) are often helpful for this problem. These drops are harmless and can be applied as often as required.

-Puffiness around the eyes

This is more difficult to treat. Using extra pillows at night may help or sometimes a water tablet (diuretic) may be prescribed for you. The swelling usually improves as the eyes begin to settle down.

-Staring eyes

This may settle with time however if the problem is very severe the appearance can be improved by surgery to the eyelids.

-Deteriorating vision

If this occurs quite rapidly specialist treatment with powerful (immunosuppressive) drugs may be needed to damp down the inflammation around the eyes. Alternatively surgery called orbital decompression or radiotherapy treatment may be considered.

-Eyelid Retraction Repair

In thyroid eye disease, or Graves' disease, the eyelids can open too widely. Once the disease has remained stable for six months, corrective eyelid surgery can be performed to lower the eyelids back to their normal position. This is done both to improve appearance and to improve the health of the eyes, (the abnormally open eyelids cannot blink properly and leaving the eye inadequately lubricated and protected). This is performed as an outpatient, often with the CO2 laser in order to minimize bruising and speed healing.

-Orbital Decompression

Some patients with Graves' disease require orbital decompression, either to protect the vision, improve comfort, or improve their appearance by letting the eyes go back into the orbit. Dr. Schiller is pleased to be able to offer state-of-the-art minimal incision orbital decompression with the incisions placed inside the eyelids. Recovery is remarkably fast with minimal bruising and a small or no external scar.

-Double Vision Correction

Double vision is often the most disturbing result of thyroid eye disease, and surgical correction provides remarkable relief for these unhappy patients. Dr. Schiller performs adjustable muscle surgery under local anesthesia with intravenous sedation, which guarantees the patient's comfort and safety, while allowing the eyes to be adjusted to achieve clear single vision after only one procedure in almost all cases.

Will the eyes return to normal?

If the eyes are mildly affected they may return to nearly normal. This can take between 12 and 24 months. If your eyes have been more severely affected it is less likely that the changes will go away. In this situation expert treatment is required and carefully planned surgery can be very effective in improving the appearance of the eyes. This may require squint and lid surgery to improve the cosmetic appearance of the eyes. However neither is 100% effective but certainly help greatly to improve the situation.

 

Prevention/Solution

·         Fixing the thyroid problem may prevent eye disease. Thyroid problems are corrected through anti-thyroid medication and surgery. There are several ways of treating eye disease, including medication for the thyroid hormone levels. Other options may include adjusting the eyelids in a way that allows them to close proper, use of rewetting drops or surgery to adjust the eye muscles. Steroids also may be prescribed to reduce the swelling.