by Thyroid eye disease, also known as Graves’ ophthalmopathy, is an autoimmune disorder where the muscles and fatty tissues behind the eye become swollen and inflamed due to abnormal functioning of the thyroid gland. While symptoms can often be mild, in some cases thyroid eye disease can cause significant damage to vision and appearance if left untreated. In this article, we explore the various treatment options available for dealing with thyroid eye disease.
Causes of Thyroid Eye Disease
Thyroid eye disease develops as a result of an autoimmune response where the body’s immune system mistakenly attacks the thyroid and surrounding tissues. The exact cause is still unknown, but genetics and environmental triggers are believed to play a role. Women are affected more often than men, and symptoms usually occur between the ages of 40-60. Those with Graves’ disease, a condition where the thyroid gland overproduces hormones, have a higher risk of developing thyroid eye disease as well. The inflammatory assault targets the muscles and fatty tissues in the eye socket.
Signs and Symptoms
Common early symptoms include dry, itchy, and irritated eyes, double vision, swollen eyelids, protrusion of the eyeballs (exophthalmos or bulging eyes), and reduced vision. As the condition progresses, signs may include redness of the eyes, inflammation of the tear glands, change in the appearance of the eyelids, and problems moving the eyes normally due to swollen muscles. In severe cases, corneal ulcers can develop from the eyes being unable to close fully, leading to blindness if left untreated.
Managing Mild Symptoms
For mild and moderate cases of thyroid eye disease, lifestyle measures and over-the-counter treatments may provide relief. Cool compress, artificial tears, and sunglasses can help soothe irritations. Avoidance of smoking and reducing stress levels is also recommended. Corticoesteroid eyedrops or ointments may reduce inflammation when used short-term under medical supervision. Most uncomplicated cases resolve on their own within 1-2 years once the thyroid condition is stabilized.
Glucocorticoid Therapy
For those with more serious symptoms affecting vision or appearance, systemic glucocorticoid therapy may be prescribed. These corticosteroid medications help reduce inflammation and swelling by suppressing the immune system. Prednisone taken orally is a commonly used option, usually for 3 months or less to avoid long-term side effects. In rare cases where immunotherapy is required, infliximab (Remicade) injections have shown benefits for recalcitrant thyroid eye disease as well.
Orbital Decompression Surgery
When Thyroid Eye Disease bulging (proptosis) is severe enough to threaten vision or cause difficulty closing the eyelids fully, orbital decompression surgery may be considered. The surgeon will remove small pieces of bone behind the eyeball to make more space in the bony eye socket and relieve pressure on nerves and muscles. Endoscopic techniques are now commonly used for less invasive procedures. Recovery takes a few weeks with risks of double vision, numbness, and facial sagging if not performed carefully.
Strabismus Surgery
For double vision caused by abnormal eye muscle movement due to inflammation (strabismus), eye muscle surgery may fix misaligned eyes. The ophthalmic plastic surgeon delicately detaches, moves and reattaches eye muscles to improve coordination. Recovery involves eye patches and glasses for a few weeks, with a high success rate for single vision. Additional procedures are sometimes needed if eye turns return due to scarring.
Other Options
Radiation therapy using focused x-rays has benefits for some refractory cases. Newer options under investigation include biologics targeting specific immune pathways and fat redistribution using injections. Artificial tear drops, punctal plugs, and eyelid spacer devices can also help with dry eyes and corneal issues. Vision rehabilitation therapist can assist with adaptations for residual functional limitations.
Outlook
Fortunately, most people see improvements within a year of treatment for thyroid eye disease without lasting vision impacts. However, 5-10% of severe cases can lead to vision threatening complications or disfigurement without appropriate management. With a multidisciplinary approach using the latest therapeutic strategies and close monitoring, outcomes continue improving. Following up with an endocrinologist is also key to optimize thyroid hormone levels and avoid future flare-ups. Understanding treatment options empowers patients to take an active role in managing their eye condition.
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1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it
