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THYROID EYE DISEASE





 

What is Thyroid Eye Disease?

Thyroid Eye Disease is a disorder of the immune system. For reasons that are not known, the lymphocytes, white blood cells that are involved in the body’s protective defences, begin attacking the body’s own tissues. Probably many different tissues in the body are involved, but the two tissues that are affected the most are the thyroid gland and the tissues around the eye.

When the thyroid gland is attacked by these lymphocytes, it responds by producing too much thyroid hormone: this causes symptoms of nervousness, rapid heartbeat, tremor, weight loss, and other features of hyperthyroidism. When the tissue around the eye is attacked, there is inflammation and swelling. The inflammation causes redness and pain. The swelling causes puffiness around the eyes and bulging of the eyes. The eye dries out because the eyelids are not able to close completely over the bulging eyes, causing more irritation.

There are currently many effective treatments to help patients get through the various stages of the disease and return to a healthy, productive life.

How is Thyroid Eye Disease treated?

In some cases, the discomfort from thyroid eye disease can be treated with topical lubricants, wrap-around tinted glasses, sleeping with eye shields and with the head elevated.

When there is active inflammation with more severe symptoms, oral cortisone or other anti-inflammatory medications may be needed to reduce the swelling. Sometimes radiation is used to treat the active inflammation of the eyes.

Once the disease reaches the post-inflammatory phase, there are chronic structural changes that do not typically improve by themselves. These permanent changes include bulging of the eye, double vision, tightness of the eyelids with a staring appearance, poor closure of the eye, and swollen puffy tissues around the eye. Even though the active inflammation is gone, there is often still some redness related to the irritation, and often pressure pain because of the congestion and poor venous outflow.

Depending on the severity of the swelling, surgery may be necessary to decompress the orbit. This is typically done once the active inflammation has gone down. Reconstructive work may also need to be done to provide better functionality and overall appearance.


How does the thyroid gland relate to the eye?

In some cases, the discomfort from thyroid eye disease can be treated with topical lubricants, wrap-around tinted glasses, sleeping with eye shields and with the head elevated.

When there is active inflammation with more severe symptoms, oral cortisone or other anti-inflammatory medications may be needed to reduce the swelling. Sometimes radiation is used to treat the active inflammation of the eyes.

Once the disease reaches the post-inflammatory phase, there are chronic structural changes that do not typically improve by themselves. These permanent changes include bulging of the eye, double vision, tightness of the eyelids with a staring appearance, poor closure of the eye, and swollen puffy tissues around the eye. Even though the active inflammation is gone, there is often still some redness related to the irritation, and often pressure pain because of the congestion and poor venous outflow.

Depending on the severity of the swelling, surgery may be necessary to decompress the orbit. This is typically done once the active inflammation has gone down. Reconstructive work may also need to be done to provide better functionality and overall appearance.


How does the thyroid gland relate to the eye?

This is an important question, and one that is confusing not only to patients but also sometimes to physicians. Even though we don’t know everything about Thyroid Eye Disease, current knowledge suggests that there is not a direct relationship between the thyroid gland and the eye tissues in Thyroid Eye disease.

They are related diseases that occur in the same patient, both probably caused by an underlying disorder in which the body’s tissues are attacked by its own immune system, but the thyroid disease does not directly cause the eye disease. That’s why treatment of the thyroid gland, while important, does not directly improve the eye disease.

The two diseases run a separate course. In fact, they can sometimes be very far apart in time, so that, for example, the eye disease may start years before or years after the thyroid gland has been affected. Sometimes patients get just the eye disease without any involvement of the thyroid gland. It surprises people to find out that you can get Thyroid Eye disease without any thyroid gland involvement, but it makes sense if you understand the basic mechanism of the disease: those lymphocytes that attack the body’s own tissues sometimes choose to attack only the eye tissues.

Because the thyroid disease may start later, patients with eye disease only – referred to as “Euthyroid Graves’ disease” – are at risk for developing thyroid disease later on and need to be monitored on a regular basis for any evidence of thyroid gland problems.


The various surgical treatments for Thyroid Eye Disease

Surgery is staged. Although some patients may get all the improvement they need with only one surgery, more often more than one stage of surgery is necessary to achieve the optimal rehabilitation.

Each surgery is considered in order: in order to minimize the total number of surgeries, each stage of surgery is considered, and a decision is made whether or not to perform that stage of surgery before going on to consider the next stage. It is usually best to allow some time between stages, often two to four months. Therefore, if a patient requires multiple stages of surgery, the entire period of rehabilitation can be lengthy, sometimes requiring a full year. Patients can normally work and return to activities one to two weeks after each surgery.


Stages of Surgery:

  • Stage 1
    Orbital Decompression
  • Stage 2
    Eye Muscle Surgery
  • Stage 3
    Eyelid Repositioning
  • Stage 4
    Sculpting and Repositioning the Prematurely Aged Face

Thyroid Eye Disease can be a very terrifying experience. There is a natural inclination to think, "Why me?".

Fortunately, there are good treatments for the disease, both in the inflammatory phase, and also in the late burned-out phase.

We can accomplish a lot to restore your appearance and self-confidence. With modern techniques, patients hardly ever lose vision permanently from Thyroid Eye disease. There is a light at the end of the tunnel. It is not a short trip, and there will be some work on your part and on the part of your team of doctors, but you can look forward to getting the worst parts of the disease behind you, getting rehabilitated, and returning to a good state of health.

 

“Vision is the true creative rhythm”

- Robert Delaunay