What is Thyroid Eye Disease?
It is also known as Graves’ eye disease or ophthalmopathy, dysthyroid ophthalmopathy, and other names. It is characterized by enlargement of the extraocular eye muscles associated with thyroid dysfunction. Thyroid eye disease is most commonly associated with hyperthyroidism (Graves’ hyperthyroidism). It can also be associated with hypothyroidism or in rare cases no thyroid abnormalities can be found.
eyelid retraction and proptosis
What Causes Thyroid Eye Disease?
The cause is not known at this time. It is a multifactorial immunological disease with mixed inflammatory cells being deposited in the extraocular muscles.
Signs and Symptoms of Thyroid Eye Disease
The signs may include: Swelling around the eyes, redness or erythema, protruding or bulging of the eyes, and eyelid retraction.
The symptoms may include: Pain in and around the eyes, diploplia or double vision, epiphora or watering of the eyes, foreign body sensation, and photophobia or light sensitivity.
Clinical Observations and Diagnosis
A patient with eyelid retraction or proptosis associated with the following clinical presentations: chemical thyroid dysfunction, extraocular involvement or muscle restriction, and optic nerve damage meet the criteria for thyroid eye disease.
Diagnostic Tests
MRI
The MRI shows enlarged extraocular muscles with a homogenous pattern with marked enhancement or uptake with gadolinium contrast.
CT Scan
Again shows enlarged extraocular muscles, protruding or proptosis of the globe
Ultrasound
Shows enlarged extraocular muscles but this test is not used as commonly.
Laboratory Tests
Thyroid profile blood test
Treatment of Thyroid Eye Disease
Medical Treatment
Oral corticosteroids orally and in severe cases IV are used in the acute active phase to decrease the inflammation.
Orbital radiation can be effective in cases that are not responding to medical treatment.
Surgical Treatment
Eye muscle surgery may be needed if the patient develops severe enough muscle movement restriction in order for them not to have double vision.
Eyelid surgery may become necessary if too much of the eye becomes exposed causing significant eye irritation.
Orbital decompression may be necessary if the muscles become so enlarged that they are pressing on the optic nerve or pressing on the eye causing glaucoma.
Complications of Thyroid Eye Disease
Exposure of the eye causing exposure keratitis and dry eye symptoms
Loss of vision due to glaucoma or direct optic nerve damage
Double vision due to extraocular eye muscle movement restriction
Medical Course and Prognosis
The active stage of thyroid eye disease lasts for approximately 1-2 years. Patients need to be closely monitored for damage to their optic nerve, possible development of glaucoma, and exposure keratitis with corneal problems.
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