Thyroid Eye Disease
What is Thyroid Eye Disease?
Thyroid eye disease, also known as TED or Grave’s ophthalmopathy, is an autoimmune condition that often occurs in people who develop an overactive thyroid gland. When a patient’s immune system attacks the muscles and tissues around their eyes inflammation occurs. In turn, the inflammation causes the eyeballs to enlarge.
Dr. Kimberly Cockerham has made the treatment of TED an integral part of her practice for over 20 years. She is an international leader in thyroid eye disease research and has been active in the development of innovative and minimally invasive therapeutic options. Dr. Cockerham can effectively address the conditions caused by TED with medical management or by performing state-of-the-art eyelid, eye muscle or orbital surgery.
Causes of Thyroid Eye Disease
Graves’ disease is behind thyroid eye disease. In Graves’ disease the patient’s thyroid gland makes too much of certain hormones. This is known as hyperthyroidism. It results in many varying symptoms: weight loss, a rapid heartbeat, high blood pressure, and irritability. But in some patients this overproduction of hormones can cause the immune system to mistakenly attack healthy cells. When this attack is on the muscles and tissues around the eyes, this is known as thyroid eye disease or Graves’ ophthalmopathy. Certain carbohydrates build up in the muscles and tissues behind the eyes when this happens. Thyroid eye disease occurs in about half of people suffering from Graves’ disease.
Thyroid Eye Disease Symptoms
Once a patient has been diagnosed with Graves’ disease, if eye symptoms are to develop they will usually do so within six months. These are the symptoms of thyroid eye disease:
- Feeling of grittiness in the eyes
- Redness or inflammation of the conjunctiva (the white of the eye)
- Excessive tearing
- Dry eye
- Swelling of the eyelids
- Sensitivity to light
- Forward displacement or bulging of the eyes
- Double vision
When the condition has advanced, these may more severe symptoms:
- Decreased eye movement
- Decreased eyelid movement
- Incomplete closure of the eye
- Corneal ulceration
- Compression of the optic nerve
Diagnosing Thyroid Eye Disease
If a patient has already been diagnosed with hyperthyroidism, we are on the lookout for Graves’ eye disease. We examine the patients’ eyes and look for swelling and enlargement of the eye muscles. We may order a CT scan or MRI scan of the eye muscles for further information.
Graves Eye Disease Treatment
Through state-of-the-art vision testing, Dr. Cockerham can diagnose your condition and recommend the most appropriate treatment based on your individual needs. The most common medical interventions are corticosteroids or external beam radiation. These treatment options are typically reserved for patients with vision-threatening active phase or rapidly progressive orbitopathy. Other treatment options include:
- Topical ointments
- Artificial tears (preservatives are bad so stay away from Visine®)
- Topical anti-inflammatory drops
- Topical, intranasal, oral, infusions behind the eye or intravenous corticosteroid treatment
- Orbital radiotherapy
- Removal of fat and sculpting of bone to restore the eye position (orbital decompression)
- Eyelid retraction repair surgery to allow the eyelids to close
- Eye muscle surgery to allow single vision
- Eyelid skin debulking, fat sculpting
- Skin resurfacing with topical products, peels, and lasers
What if Thyroid Eye Disease is Left Untreated?
As your eyelids retract, the patient will suffer more and more corneal ulceration. In the most severe cases, this can increase pressure on the optic nerve. If this is left untreated, this results in vision loss. There is no reason for this, as thyroid eye disease and Graves’ disease in general can be successfully treated.
Corticosteroids for TED
As mentioned above, a common treatment for TED is corticosteroids. There are two types of corticosteroid treatment including oral and intravenous. Oral corticosteroid treatment, usually Prednisone, has been shown in 65% of cases to produce a short-term decrease in soft tissue swelling, optic neuropathy, and extraocular muscle size. Intravenous corticosteroids have been tested in clinical settings. The positive response from patients using intravenous corticosteroids is as high as 85%. Patients also display fewer side effects than oral corticosteroids such as Prednisone.
External Beam Radiation for TED
Another common treatment for TED is external beam radiation. Studies show that overall improvement rates of 60-65% are typical in reported studies treating TED patients that are in the active phase of the disease. However, data addressing the efficacy of orbital irradiation, either alone or in combination with other treatments such as corticosteroids, steroid-sparing agents, and surgery are conflicting. Radiation can decrease redness, swelling, and discomfort as well as be used effectively if optic neuropathy is present. If patients are experiencing double vision, want to reduce proptosis or have diabetes then radiation is not the recommended course of treatment.
Thyroid Eye Surgery Procedure
In most cases, surgery is delayed and is targeted at modification of stable phase dysfunction. There are a few different surgery options for patients. These options will vary patient to patient depending on your issues and Dr. Cockerham’s recommendations during your consultation.
- Orbital Decompression Surgery is effective in decreasing or eliminating the bulging or proptotic eyes.
- Eyelid Retraction Repair Surgery is effective in decreasing or eliminating the stare that is so characteristic of TED. The eyelids often staying open at night and cause a break down of the surface of the eye.
- Eye Muscle Surgery is effective in restoring a single vision when looking straight ahead and down. However, there is no way to return the muscle function to normal so double vision in extremes of gaze is a common permanent change.
Late surgical interventions can help decrease disfigurement and allow the patient to see a single image when looking straight ahead. Unfortunately, the tissue alterations are irreversible and there is no way to restore normal eye muscle movement or pre-disease appearance. Thus, many of the manifestations of TED are permanent.
Orbital Decompression Surgery
The eye is surrounded by bone on all sides except in the front, so the eye protrudes outward. This protrusion occurs when a patient is suffering from inflammation and swelling of the eye muscle and fat. Besides appearance, it is a concern that continued compression can eventually affect the optic nerve, causing further damage. In order to relive the compression operation, orbital decompression surgery, to remove parts of the surrounding bone is performed. The images below display the steps taken during orbital decompression surgery in order to rid the patient of bulging or proptotic eyes.
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If you would like to learn more about Thyroid Eye Disease call 1-800-244-9907 to make an appointment at Central Valley Eye Medical Group.