Thyroid Eye Disease (Thyroid Ophthalmopathy)

Thyroid Eye Disease

Thyroid Eye Disease

General Overview:

Thyroid Eye Disease (also called TED or thyroid ophthalmopathy or thyroid orbitopathy) is a disease condition of the eye, wherein the ocular muscles and fatty tissue behind the eyes get inflamed. This may lead to forward displacement or bulging of the eye (proptosis). The eyes and the eyelids turn red and become swollen. In some cases, there occurs stiffening and swelling of the eye & ocular tissues which tend to move the eyes in such a way, that the eyes are no longer in line with each other, which may lead to diplopia (double vision). Very rarely, TED can produce blindness, as a result of pressure on the optic nerve at the back of the eye or lead to corneal ulcer formation in front of the eye.

Thyroid Orbitopathy is an autoimmune disorder. When the immune system of the body attacks the eye causing inflammation, TED results. TED is mainly found to occur in persons with an over-active thyroid gland (hyperthyroidism) due to Grave’s disease, however it may even be found in people with an under-active (hypothyroidism) or a normally functioning thyroid gland. Grave’s disease is one of the most important factors/causes responsible for producing. Hence, TED is also termed as “Grave’s Orbitopathy”.

TED may lead to multiple problems of the eye. These problems are such as swelling and redness, decreased vision, diplopia (double vision), bulging eyes (proptosis) and eyelid retraction (superior displacement of the upper eyelid).

Eye problems will generally take place and often change in severity or type in the initial period of 6 months to 2 years. Once stabilized, it is not usual for the eyes to change again. Some patients are left with permanent changes in the eye. Whereas, in the rest, the eye returns to normal.

Predisposing factors:

  • TED is generally associated with generalized (systemic) hyperthyroidism or Grave’s disease. Grave’s disease is an autoimmune process. By autoimmune disease, it is meant that it is a process by which the body sees some part of itself as being foreign and reacts to in much in the same manner as it would to a bacteria or a virus.
  • In case of Grave’s disease, the body sees its own thyroid gland as being foreign and produces antibodies, which attack the thyroid gland. This often leads to damage & the over-activity of the thyroid gland.
  • In case of TED, the different antibodies which are produced, attack the ocular muscles which are concerned with eye and eyelid movement. Though the thyroid gland and the eye may be under influence of attack by the same immune system, both of these conditions remain independent of one another. The antibodies attacking the eye may produce inflammation and swelling of the muscles and fat around the eye, which further leads to forward displacement of the eye, retraction of the eyelids and double vision.
  • Smoking is also said to be one of the important factors responsible for causing TED.

Clinical Presentation:

The most common symptoms which patients present with are as follows:

Ø  A feeling of grittiness, burning, irritation in the eyes

Ø  Change in the appearance of the eyes (staring or bulging eyes)

Ø  Sensitivity to light

Ø  Dry or watery eyes (teary eyes)

Ø  Redness of the eyes and eyelids

Ø  Swelling of the upper and lower eyelids

Ø  Pain in or behind the eye, especially when looking up, sideways or down

Ø  Double vision or blurring of vision

Ø  Difficulty in moving the eyes

How is TED diagnosed?

Diagnosis can be made by simply examining of the eyes.

If  there is pre-existing thyroid gland problem, then some tests are mandated.

  •  Blood tests:

Thyroid Function Tests (TFTs) are required to back up the diagnosis. These tests help in determining whether the thyroid gland is functioning well by measuring its hormones (chemical messengers) ie. T3,T4 and TSH in the bloodstream. More specialized blood tests can be performed to measure the presence of the various antibodies in the bloodstream.

  • Scans:

Thyroid uptake scans are performed occasionally to assess the functioning of thyroid gland. If swelling in the orbit is suspected, MRI can be performed which will help to assess the tissues that have been most affected (for instance, the thickening of the extra-ocular muscles).

  •  Other tests:

For assessment of general sight including peripheral vision and the ability to see colours, tests such as vision tesing, colour vision testing, visual fields, exophthalmometry, eye pressure readings, eyelid measurement etc may be carried out. Eye movement test can be carried out to assess which muscles have been affected and to diagnose any limitation of ocular motility.

Treatment:

  • Artificial tear drops may be helpful in mild cases, where the eyes feel gritty with lots of watering and sensitivity to bright light.
  • Selenium supplements are useful in cases of mild TED.
  • Surgery may be helpful in such cases. In more acute and vision threatening cases, surgery combined with other treatments like intra-venous steroids and radiotherapy are carried out.
  • Rehabilitative surgery may involve:

Eye muscle & Squint surgery – for treating double vision

Eyelid surgery – for improving the appearance of the eyelids

Orbital Decompression surgery’ – to create more space behind the eyes when there is pressure on the optic nerve or when there is lot of protrusion of the eyeballs (proptosis). Orbitotomy & Orbital Decompression Surgery are performed for improving a person’s cosmetic appearance, as well as for functionally rehabilitating the patient.

  • Other treatments such as prisms attached to spectacles in order to improve double vision and high dose steroids may be beneficial.

Prevention:

  • Give up smoking.
  • Avoid fluctuations in thyroid levels.

Graves disease treatment through orbital decompression surgery

If you have thyroid disease, you must know that Graves’ disease involving the eyes, is one of the most common consequences. In fact, Graves’ disease happens to be quite a common consequence of the thyroid disease and it was first diagnosed way back in the 19th century. Also, Graves’ disease has been attributed to be one of the leading causes of hyperthyroidism. This is a condition which affects the thyroid gland and makes it produce excessive thyroid hormones. The good news is that if you have been correctly diagnosed with Graves’ disease, treatment will not prove very difficult. Of course, the trick lies in starting of Graves’ disease treatment as soon as possible. However, if the condition is left untreated, then it can well lead to serious consequences.

Orbital decompression surgery for thyroid disease treatment

Sometimes, orbital decompression surgery becomes the most suitable treatment for people suffering from exophthalmos and Graves’ disease due to their thyroid.  So what is orbital decompression surgery? Well, orbital decompression surgery is the partial or complete removal of one or more of the four walls of the orbits of the eye socket. Understanding when and why orbital decompression surgery may become a requirement for Graves’ disease treatment is important.

When is orbital decompression surgery a need?

Your doctor will be the right person to tell you when you are going to need orbital decompression surgery. When Graves’ disease combines with another condition such as lid lag, bulging of the eyes, or double vision, then your doctor may suggest this surgery for treatment. So should you get this procedure done? The best way to go about it is to have a frank consultation with the doctor who is treating you. If you are already getting treated for thyroid disease, then it is a good idea to talk to your doctor about your Graves disease as well. If he suggests the surgery, make sure that you ask for orbital decompression surgery before and after photos because that is going to tell you about whether or not you would want to go for it. Looking at before and after photos of orbital decompression surgery is also a good way of finding out whether the results will be worth your while.

Understanding that surgery for thyroid eye disease may be essential

You should understand beforehand that sometimes surgery for thyroid eye disease is essential for treatment. Taking a decision after looking at before and after photos of the surgical procedure will help you arrive at your decision more swiftly. The truth is that surgery for Graves’ disease treatment in the form of orbital decompression is basically a safe procedure and one that your doctor may well suggest if your condition is affecting the quality of your life. However, as with any kind of surgery, there are risks in this as well. However, whether or not the risks undermine the actual procedure is something you should judge for yourself.

Risks associated with orbital decompression surgery

Here are some of the risks associated:

  • Double vision
  • Bleeding
  • Infection
  • Loss of vision

However, the truth is that such risks are an inherent part of almost all kinds of surgery so you don’t really have anything to worry about.

The right oculoplastic surgeon

We cannot stress how important it is to find the right oculoplastic surgeon for your thyroid disease surgery. It is extremely important that you find someone very experienced. He should not only be good at plastic surgery, he should also have very good knowledge about the human eye and how it works. This is because orbital decompression for Graves’ disease can be done on any of the walls of the orbit of the eye. Deciding which wall the decompression should be for is the first step that the oculoplastic surgeon should take. In some patients, going aggressively is the key for great before and after photos while in some patients, the key lies in going as slowly as possible. Deciphering which kind of treatment to give a patient is the most important task of the surgeon.

The right surgeon should be fully knowledgeable about your thyroid condition and the fact that you suffer from Graves’ disease. This is extremely important. Also, the surgeon should talk to you about all the risks that are involved in the surgery because that too is super-important. There are some risks associated with the surgery such as the leaking of the cerebral spinal fluid and only a very good and highly experienced surgeon can deal with it. You should know that in the hands of a good surgeon the procedure can be an extremely less invasive one. So take your time in choosing a surgeon for orbital decompression procedure for thyroid disease. With a little bit of time and effort, you will be able to find the best surgeon for the procedure. Visit Dr. Debraj Shome at the Esthetic Clinics in Mumbai, India, for your orbital decompression surgery and great cosmetic results.