What is Thyroid Eye Disease?

Thyroid eye disease is an autoimmune condition that is usually associated with hyperthyroidism or Graves' disease. Some patients may develop thyroid eye disease without any changes in thyroid hormone levels. It is the most common orbital disorder in adults. Thyroid eye disease is also known as thyroid-associated ophthalmopathy.

Thyroid eye disease can affect anyone, although is more common in women and in smokers.

Symptoms of Thyroid Eye Disease

The most common symptoms of thyroid eye disease are:

  • Eyes may initially feel dry, gritty, and irritated
  • Eyelid swelling and retraction
  • Bulging of the eyes
  • Development of double vision, especially when glancing upward
  • Face has unbalanced appearance
  • Vision loss

Treatment for Thyroid Eye Disease

Treatment for thyroid eye disease is complex and often involves several physicians including a neuro-ophthalmologist, an orbital specialist and an endocrinologist. Your doctors may order laboratory tests to assess the activity of your disease.

There are two phases of thyroid eye disease. The first phase can last as long as 36 months, during which symptoms build gradually. However, symptoms can be sudden in some patients. After this time, eye symptoms usually stabilize. During this initial phase, treatment involves managing and treating the underlying thyroid disease, as well as reducing discomfort, avoiding double vision and preserving sight.

Treatments can include:

  • Using artificial tears at night
  • Corticosteroids to reduce swelling
  • Radiation treatment to the orbit
  • Patching one eye or using prism glasses to manage double vision
  • Orbital decompression surgery for vision loss from optic nerve compression

During the second phase of thyroid eye disease the eye symptoms stabilize and treatment involves correcting any unacceptable permanent changes such as protrusion of the eyes and the appearance of staring. These conditions can be addressed with surgery. If double vision continues after the initial stage, this can also be corrected with eye muscle surgery.

It is very important that an ophthalmologist monitors the eyes to avoid vision loss from optic neuropathy, a rare but serious potential complication of thyroid eye disease. Most patients do well and 75 percent of patients require only supportive therapy. The majority of patients do not develop sight-threatening complications. The disease usually runs a self-limited course of 18 to 36 months.

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