Most eye surgeons (ophthalmologists) and hormone specialists (endocrinologists) will be in contact with an oculoplastic surgeon with experience in treating patients with thyroid eye disease. They work as a team to manage the problem.
An oculoplastic surgeon is a plastic surgeon with extensive training in managing the cosmetic and eye complications of thyroid disease. Plastic surgeons who are members of the American Society of Ophthalmic Plastic and Reconstructive Surgeons (ASOPRS) are a part of this team.
Dry eyes, corneal ulcers and eye muscle weakness can be managed by ophthalmologists trained in these complications. Orbital decompression (a complex procedure for advanced disease) requires a plastic surgeon.
What is thyroid eye disease?
Thyroid eye disease, also known as Graves’ orbitopathy or Graves’ ophthalmopathy, is an eye condition that happens in a person with an overactive thyroid.
An overactive thyroid, known as hyperthyroidism, results from elevated levels of thyroid hormones in the blood.
The signs and symptoms of thyroid eye disease include
What causes thyroid eye disease?
Thyroid eye disease is caused by Graves’ disease, an autoimmune condition in which the body’s immune cells cause the tissue around and behind the eyes to grow. This causes the eyeballs to protrude. This, along with the loss of facial fat, results in the typical appearance of bulging eyes, which is the typical appearance of a person affected with thyroid eye disease.
In most patients, the same mechanism that causes thyroid eye disease can also affect the thyroid gland and result in an overactive thyroid. Thyroid eye disease may happen in a person months before the diagnosis of an overactive thyroid or after receiving treatment for Graves’ disease affecting the thyroid. Receiving iodine therapy for Graves’ disease increases the risk of thyroid eye disease. The eye condition can also occur in people in whom the thyroid is underactive or is functioning normally.
How is thyroid eye disease diagnosed?
If the patient already suffers from hyperthyroidism, the ophthalmologist will check for
- The functioning of the eye muscles
- The extent to which eyelids can be closed
- Range of motion in the eyes
- Visual acuity test
- Color vision
Other tests that are used to arrive at the diagnosis of thyroid eye disease include
- Computerized tomography (CT) scan of the eye muscles
- Magnetic resonance imaging (MRI) of the eye muscles
If the affected person doesn’t have thyroid disease, the doctor will ask for blood tests that check for
- Thyroid hormone levels (T3 and T4)
- Thyroid-stimulating hormone (TSH) level
- Thyroid-stimulating immunoglobulin (TSI) level
- The presence of antithyroid antibodies
How is thyroid eye disease treated?
Earlier, surgery was the only option for most patients with thyroid eye disease. However, with the advances in treatment, surgery can be delayed or avoided. Here are the treatment options available for thyroid eye disease
- Prisms: Spectacles containing prisms can help people with double vision.
- Steroids: The inflammation in the eyes that causes them to swell can be reduced effectively by steroids. The most commonly used ones include hydrocortisone and prednisone.
- Eyelid surgery: Surgery involves repositioning the bulging eyelids to allow them to close properly.
- Eye muscle surgery: The shortened eye muscle in Graves’ disease can pull the ligaments and result in double vision. The surgery involves cutting the eye muscle and reattaching it to correct double vision.
- Orbital decompression surgery: The excess bone is cut to allow the eye to expand properly. This surgery is usually reserved for patients who are at a heightened risk of losing their eyesight due to thyroid eye disease.
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