What is thyroid eye disease?
The thyroid is a very important gland, located in the neck. It helps to regulate various functions by releasing thyroid hormones (T3 and T4) in the blood. It plays a very important role in the growth, development, and metabolic processes of the body.
Thyroid eye disease is a very unique condition. Thyroid eye disease is also considered a part of Graves eye disease. Another name of it is Graves ophthalmopathy. In Hashimoto thyroiditis disease, thyroid eye disease can also occur. Following names are also used to describe thyroid eye disease-
- Graves orbitopathy.
- Graves ophthalmopathy.
- Thyroid-associated orbitopathy.
Thyroid eye diseases belong to autoimmune disorders. The immune system of humans is designed to destroy viruses and bacteria, but in the case of patients with an autoimmune disorder, the immune system targets normal tissues of the body. The body’s immune system attacks the Thyroid gland. Besides the thyroid gland, In Graves disease, the immune system of the patient attacks the muscles, and fat tissues behind the eye (orbital and periorbital tissue) and then subsequently causes inflammation and formation of scars occur.
Almost forty percent of people with Graves disease suffer from eye symptoms. Though the symptoms are mild, they can create a great impact on the quality of life.
Who gets it?
People with hypothyroidism or hyperthyroidism are more prone to develop this. Also if you have an underactive thyroid you may develop this. You can also get this disease even if you have a normal thyroid level, but these types of instances are very rare.
Flare-up stages of thyroid eye disease may last from six months to two years. Treatment may shorten the period.
Symptoms of thyroid eye disease
- Redness of the eye and swelling of the eyes
- Bulging of the eyeball
- Strabismus of the eye meaning misalignment of eyes that doesn’t work together
- Eyes become dry
- Gritty sensation of eyes
- Eyes become watery
- Eyelids become swollen
- The eyelid becomes red
- Sensitivity towards the light
- Vision changes
- Diplopia ( double vision)
- Eyes become excessively dry
- Pain behind or around the eyes
- Facing difficulty in moving eyes
- Formation of bags under the eyes
Diagnosis
- Mainly thyroid eye disease is diagnosed clinically.
- Assessment of thyroid hormones to know if the thyroid gland is hyper or hypoactive.
- In the case of thyroid eye disease color vision is abnormal( pt may see the lights dimmer than usual), the optic nerve may be compressed, ulcers may develop in the cornea, sharpness of vision is hampered – all these help to detect thyroid eye disease clinically.
- To diagnose the vision change accurately, vision testing, visual field test, color vision test, measuring eyelids, taking readings of eye pressure, optic nerve checking, etc are done.
Treatment
- Taking antithyroid medications to treat hyperthyroidism. Methimazole is the ideal choice since it has fewer side effects.
- Beta-blockers help to reduce the symptoms of hyperthyroidism.
- Previously Radioactive iodine has been used in treating Graves disease but studies suggested it worsen symptoms of thyroid eye disease.
- Most of the time if people feel grittiness in their eyes, they may use artificial tear drops or gels, it may provide comfort to their eyes and protect the surface of the eyes.
- Using lubricant gel is another option.
- To remove irritation temporarily- Cool compression is done. It is done before going to sleep or just getting up in the morning.
- Steroids help to reduce inflammation and thus improves double vision.
- In a few cases, injectable prednisolone is used.
- In some cases, corticosteroids are paired up with radiotherapy or immunosuppressive agents.
- Use special spectacles having prisms to help double vision.
- Using sunglasses to protect yourself against light sensitivity. Besides this, it may protect you from wind or direct breezes from fans.
- Use of patch to help patients with double vision.
- While sleeping, keep your head raised to reduce swelling. It will reduce pressure on the eyes.
Avoid smoking, it worsens the conditions more.
- Surgery: Thyroidectomy is an option to treat hyperthyroidism but it is done after consulting specialists.
- Surgeries help to restore the normal functions of the eye and the shape of the eye, eyelid, and area around it. Usually, surgery is not done during the active phase. Some types of rehabilitation surgery help to improve the appearance of the double vision eyes such as:-
- Eye muscle surgery to treat the patient with double vision.
- Decompression surgery – when there is pressure on the optic nerve or excessive protrusion it helps to create space and thus eyes are being protected.
- Eyelid surgery is also recommended.
Is it a medical emergency?
If not treated the consequences can be severe. Though less than five percent of people TED becomes severe. If the eyelid is unable to close properly it may lead to a corneal ulcer which can lead to vision loss. In a rare case optic nerve may be compressed and develop to vision loss. But with early intervention, this disease can be improved.
There are certain signs which indicate urgent referral to specialist doctors.
- The blurry vision is not improved by blinking or covering eyes.
- Loss of brightness of the objects.
- Symptoms getting worse over a few days or weeks.
- Tilting of head to avoid double vision.
It is a medical emergency if not treated early and efficiently it may cause permanent vision loss.
Triggering factor of thyroid eye disease
- Smoking: it is said that smoking increased five times more than non-smokers.
- Genetic factors.
- A person having Iodine therapy to treat hyperthyroidism.
Final words
After diagnosing thyroid eye disease Eye symptoms usually stabilize after a few months. After getting proper treatment symptoms to get improved. Mild cases often resolve spontaneously. Early use of anti-inflammatory drugs helps to shorten the duration of the active stage of thyroid eye disease.
