Thyroid Eye Disease Management

What is Thyroid eye disease?

Thyroid eye disease is a condition that causes the muscles and soft tissues of your eye socket to become inflamed and swollen. This pushes the eyeball forward (some call it the ‘bulging’ or ‘staring’ look) and affects the movements of the eyeball.

thyroid eye disease management

It happens when you have a problem with your thyroid gland.  Thyroid Eye Disease is an autoimmune disease. It is mainly associated with an over-active thyroid ((hyperthyroidism). One common cause of an over-active thyroid is from Graves disease. Although, it does sometimes occur in people with an under-active or normally functioning thyroid. Sometimes thyroid eye disease precedes the thyroid problem.

Who develops thyroid eye disease?

Thyroid eye disease occurs generally to middle aged people. If you do carry the genes, it also makes you more likely to develop thyroid eye disease. The chances increase in particularly if you smoke.

16 women and 3 men in every 100,000 people are affected every year. Most of these people also have a problem with an overactive thyroid gland (hyperthyroidism) and have an underlying autoimmune condition.

What are the symptoms of thyroid eye disease?

These are the most common symptoms; the two eyeballs are not always equally affected:

  • Swelling and redness in one or both upper eyelids

  • Difficulty moving the eyes

  • Pain behind the eye, especially when looking up, down or sideways, tends to be worse in the mornings

  • The front of your eyes may feel dry and become red and irritated

  • Change in the appearance of your eyes. Your eyes may look bulgier. This happens when the muscles and fat surrounding your eye swell

  • You may have double vision (diplopia) as the muscles become too swollen to work properly. Remember if you experience double vision, you should stop driving

  • Blurred vision and colours can appear less vivid in more severe cases. This happens when the swelling of the muscles which move your eyes produces unequal movements

  • Difficulty seeing under bright lights or a mild sensitivity to light (photophobia)

Thyroid eye disease can be difficult to diagnose. Patients may be treated for conjunctivitis, allergy or hayfever for months before the diagnosis is made. 

Here are the main differences:

  • Symptoms may occur in the wrong season for hay-fever

  • Allergies usually cause itchy eyes, whereas Thyroid Eye Disease does not

  • Conjunctivitis usually causes sticky eyes, whereas Thyroid Eye Disease usually does not

  • Thyroid Eye Disease often is associated with an ache or pain in or behind the eye, especially when trying to look up or sideways, whereas the other causes do not

  • Thyroid Eye Disease is sometimes associated with double vision, whereas the other causes are not 

What treatments are available for people with Thyroid Eye Disease?

The first priority is to manage the primary thyroid problem. For an overactive thyroid, there is anti-thyroid drugs, surgery or radiotherapy. This treatment often produces an underactive thyroid, which then requires treatment with thyroid replacement therapy. Sometimes, the treatment for your primary thyroid problem can make your associated eye condition worse.

Once your primary thyroid problem is under control, in mild cases, if your eyes feel dry, watery and uncomfortable in bright lights, artificial tear drops or lubricating eye drops will be prescribed to help your eyes feel more comfortable.

Selenium supplements (100mcg twice daily for six months) are beneficial in patients with mild Thyroid Eye Disease.

You would need to be prepared that for the first 6-12 months that the symptoms will worsen before improving. It can take up to two years before the inflammation goes away.

Unfortunately, many people with Thyroid Eye Disease would be left with permanent physical changes in their eyes. Usually, surgery by a trained ophthalmologist and eye plastic surgeon can improve its appearance.

Rehabilitative surgery may involve:

  • In very severe cases, ‘Decompression’ surgery to create more space behind the eyes. This is done when there is pressure on the nerve or if there is a lot of protrusion of the eyeballs.

  • Eye muscle surgery to treat double vision; and/or

  • Eyelid surgery to improve the appearance of the eyelids

Other treatments for Thyroid Eye Disease include:

  • Prisms attached to spectacles or stick-on prims to help with double vision.

    Prisms work by bending light in a direction which compensates for the angle between the eyes. They can be tailored to match the angle between your eyes, and fixed to spectacles.

  • High dose steroids, to improve double vision. In less common cases where your vision is at risk, your ophthalmologist may recommend ‘immunosuppressant’ treatment (usually steroids) to help reduce the inflammation.

What will happen after treatment?

Thyroid eye disease is temporary. If you had inflammation, it tends to last for months up to approximately 2 years, after that there is a healing period.

Most people do not develop permanent complications. However, where treatment is delayed or where the thyroid eye disease has been severe, there can be lasting effects.

Possible complications include:

Complications from the disease

  • Damage to the clear window of the eye (the cornea).

  • Permanent squint or double vision (diplopia).

  • Damage to the nerve of the eye, resulting in poor vision or colour appreciation.

  • Altered appearance (eyes more protruding).

There is a lot that can be done to help people with Thyroid Eye Disease, from artificial tear drops to surgery. If you notice any of the symptoms mentioned above, make an appointment earliest possible to visit Dr. Vanessa. Don’t let Thyroid Eye Disease affect your psychological and social well-being.

You can also fill out the form or book an appointment on the Contact Us page, and we will contact you as quickly as possible.

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