Thyroid Eye Disease, commonly abbreviated as TED (other names include: Graves’ Ophthamolopathy, Thyroid Orbitopathy and Graves’ Orbitopathy) is actually a condition of the soft tissues such as the fat and muscles surrounding the eyes. The condition is characterised by a period of inflammation and engorgement of these tissues, followed by a healing response.
It is an auto-immune eye condition. It can sometimes occur in patients who have no thyroid dysfunction, or patients who have thyroid hypo-function. Most patients with thyroid diseases do not develop thyroid eye disease or, if they do, it is only mild. A small proportion develop thyroid eye disease, which may go on to require treatment either with eye drops or surgery.
What are the signs and symptoms of Thyroid Eye Disease?
Signs and symptoms include:
- Pain in the eyes, pain when looking up, down or sideways
- Dryness, itching, dry eyes, difficulty wearing contact lenses
- Inflammation and swelling of the eye, and its surrounding tissues
- Swelling in the orbital tissues which causes the eye to be pushed forward — referred to as exophthalmos — which can make Thyroid Eye Disease sufferers appear to have a wide-eyed or bulging stare
- Bloodshot appearance to eyes
- Double vision (doctors call it diplopia)
- Impaired vision
Thyroid Eye Disease is known to go through varying degrees of severity, and can go into periods of remission as well. When it has been inactive for a period of around a half a year, it’s less likely to recur. Treatments for Thyroid Eye Disease range from lubricating eyedrops and ointments to, in very rare cases, surgery. In a very small percentage of patients, orbital decompression may be called for.
How can Thyroid Eye Disease affect sight?
If the muscles become swollen, then this can affect how well the muscles are able to control the ability of the eyes to move together. This can cause double vision. This is a symptom which occurs when the eyes do not quite point in the same direction and therefore each sends a slightly different message to the brain. When this happens, our brain sees ‘two’ of everything. This can make activities like reading very difficult, and driving very dangerous.
In severe Thyroid Eye Disease, especially in younger patients whose firm tissues do not allow the eyes to bulge forwards, the pressure inside the orbits increases, compressing the optic nerve and causing sight problems. The optic nerve carries the messages from the eye to the brain and can be damaged by pressure
If the pressure starts to compress the optic nerve, sight may become dim, colours begin to look washed out, and the visual field may constrict. If this starts to happen, then medical attention needs to be sought as soon as possible, to reduce the pressure on the optic nerve before permanent damage occurs.
What are the treatment options for Thyroid Eye Disease?
The active stage which may last up to two years can be controlled with oral medications and lubricating drops. In the majority of cases, the active inflamed stage of TO burns itself out in about two years, leaving a variable amount of scarring, with lid retraction, exophthalmos or double vision.
If, after the thyroid orbitopathy has burned itself out, there are still problems with the eyes (including exophthalmos, lid retraction and double vision), then it becomes necessary to decide whether or not to have further surgery.
Usually the operations are performed in the following order: orbital decompression, surgery to the muscles for double vision and surgery to correct the lid position. Typically these operations are carried out over about 18 months to 2 years in stages if necessary.
With Shekar Eye Hospital’s modern surgical techniques, very few people are left to cope with the difficult after-effects of Thyroid Eye Disease. Our modern surgical techniques now aim to restore the position, function and appearance of the eyes to as near to normal as possible.