Systemic Eye Diseases

Thyroid Eye Disorders

Thyroid Eye Disease 

A systemic disease is one that affects multiple organs within the body. This can include the eyes. Thyroid eye disease (TED) is one such disease that causes an inflammatory response in the eyes and surrounding tissues. TED is also known by other names, including thyroid orbitopathy or Graves’ ophthalmopathy.

TED is an autoimmune reaction that causes the eye tissues—the eye muscles, tear glands, eyelids, and fatty tissue—to swell. This pushes the eyes forwards and they become red, swollen, and uncomfortable. They also take on a bulging or staring appearance. In some cases, the symptoms are so severe that the eyes can no longer move in line with each other.

As well as the eyes, around 90% of sufferers also have a disease that affects the thyroid gland. This is known as Graves’ disease. This tends to be when the thyroid is overactive—known as hyperthyroidism. But rarely it can cause the gland to become underactive (hypothyroidism). TED can also occur in people with a normally functioning thyroid. 

Because of the complexity of the condition, those who suffer from thyroid eye disease need to have a treatment plan served by both an ophthalmologist (specialist eye doctor) and an endocrinologist (thyroid specialist).

How Do I Know If I Need an Ophthalmologist Specializing in Thyroid Eye Disease Near Me?

Thyroid eye disease is often misdiagnosed at first. This is due to some of the symptoms being very similar to other conditions, such as hay fever, allergies, or conjunctivitis. Because TED can have a significant impact on a sufferer’s quality of life, expert treatment should be sought at an early stage to determine the problem.

Thyroid eye disease, along with other systemic eye diseases, is best diagnosed by a specialist service. An easy way to find a local provider is to enter “eye disease specialist near me” or “eye disease doctor near me” into any search engine. This will bring up a list of those in the vicinity. However, depending on the severity of the condition, you may consider traveling to take advantage of some of the more cutting edge treatments only available from the most advanced eye practitioners.

Symptoms that might alert you to seek advice from an ophthalmologist specializing in thyroid eye disease include:

    • Changes in the appearance of the eyes: Bulging or staring
    • Swelling: Both the upper and lower eyelids can be affected
    • Pain: Behind or in the eye. This can be more apparent when looking down, up, or to the side
    • Dry or gritty eyes
    • Difficulty in moving the eyes
    • Redness: In the eyes themselves and/or around the lids
    • New bags under the eyes
    • Photophobia: An intolerance of bright light
    • Blurred vision: Including double vision
    • Watery eyes
    • Headaches: As the swelling increases this can cause pressure pain or a deep headache. It typically worsens when you move your eyes

What Happens During Thyroid Eye Disease Treatment? 

There are various treatments for thyroid eye disease, ranging from drug therapy to surgical intervention. The most suitable for your condition will depend on many factors and will be agreed on through discussion with you and collaboration between your ophthalmologist and endocrinologist.

TED follows a 2-phase disease course. The first is known as the active stage, where the symptoms will worsen, before waning and entering stage 2, the more stable phase. Stage 1 typically lasts for anything from 1-3 years (it lasts longer in those who smoke), after which the condition stabilizes. Early treatment is key to reducing the severity of the symptoms. 

Treatment options include:

  • Gaining normal systemic thyroid hormone levels: Various drugs are used to regulate the production of the thyroid hormones. Other options include radioactive iodine ablation or a thyroidectomy.
  • Steroid treatment: To reduce inflammation and swelling of the eye tissues. This can be through oral steroids (such as prednisone) or, if this is ineffective, intravenous steroid treatment.
  • Orbital radiotherapy: Usually used in combination with steroid treatment, this involves targeting the tissue behind the eyeball with a controlled beam of radiation to decrease the orbital pressure.
  • Surgical orbital decompression: If the swelling becomes too severe it can cause pressure on the optic nerve. There are many different approaches to the procedure, all aimed at relieving pressure on the optic nerve and blood supply.
  • Treatment of eyelid retraction: This can be treated non-surgically (through steroid injections, fillers, or Botox) or with surgery to relieve tension. One such treatment is a blepharotomy. This involves a small incision being made in the eyelid to help it lengthen and close correctly.
  • Strabismus correction: Strabismus (crossed eyes) can occur from the swelling and tightness of the eye muscles. It’s generally treated with prism lenses. However, if these are not suitable or unsuccessful. then surgical intervention might be needed. Botox injections are also used in some cases.

How Can A Thyroid Eye Disease Specialist Near Me Help With This Condition? 

During both the acute and stable phases of thyroid eye disease, it’s essential to have regular assessments/treatment. Although it’s rare for TED to cause permanent vision problems, if left untreated this becomes more of a possibility. 

There’s no doubting that thyroid eye disease can be a life-debilitating condition. Symptoms like double vision, developing ulcers around the eye if the eyelid can’t close properly and, in untreated and severe cases, optic nerve compression can cause loss of vision. Early intervention is key to managing the condition.

As well as being able to prescribe medication and/or carry out any necessary surgical procedures, a specialist will advise on other aspects that have a direct impact on the severity and progression of the disease. These include:

  • Stopping smoking: Smokers are far more adversely affected by TED than non-smokers. Not only are they more likely to suffer in the first place, but the condition lasts for longer, symptoms are more pronounced, and the risk of permanent vision damage is higher. 
  • Other lifestyle modifications: Such as reducing your salt intake, sleeping in a position where your head is elevated, wearing sunglasses, and taking a supplement of Selenium.
  • Dry eye management: You may be prescribed drops or ointment to help keep the eyes moist.
  • Pain relief: Either over-the-counter drugs or prescription analgesia.

Advice on stress reduction: Recent studies show a link between stress and the severity of thyroid eye disease.

What are the main thyroid eye disease treatment options?

Treatment will depend on the severity and progression of the disease. An ophthalmologist will use a step-wise approach dictated by how early in the evolution of the disease you seek advice. 

The main options available are:

  • Treatment of dry eyes: Through eye drops and/or ointments
  • Pain relief: Over-the-counter or prescription medication
  • Selenium: For mild symptoms, Selenium has been shown to have a positive effect on the disease
  • Steroid therapy: Either oral or, in severe cases, IV steroids, can prevent and reduce the inflammation associated with TED.
  • Drug therapy: Including those that regulate the production of thyroid hormones and diuretics to help reduce swelling (due to fluid buildup).
  • Radiation treatment: To decrease swelling of the tissue behind the eyes.
  • Surgical intervention: Many options are available. These include decompression of the pressure within the eye socket, eyelid treatments, surgery to relax the muscles within the eyes, or the removal of the thyroid gland.

Some surgical treatments are not carried out until the condition has settled into the second stable phase.

What kind of doctor treats thyroid eye disease?

Thyroid eye disease is treated by a specialist eye doctor, known as an ophthalmologist. However, surgical intervention requires further expertise from those who’ve undergone additional training to treat TED. These surgeons are known as oculoplastic surgeons. 

In addition to your expert eye doctor, thyroid eye disease is also treated by an endocrinologist. Because the condition is caused by a complex relationship between the thyroid gland and its effect on the eyes, these experts will communicate with each to determine the best course of action for your condition.

What is thyroid eye disease?

Thyroid eye disease, also called TED, or Graves’ Orbitopathy, is a condition where the eyes, eyelids, and muscles in and around the eye become red and swollen. Depending on the severity of the disease, this can cause pain deep within the eye socket (usually worse when you move the eyes), a feeling of grittiness, dry eyes, retraction of the eyelids, and bulging or staring eyes. It can also cause double vision. 

It’s an autoimmune condition whereby the body’s immune system attacks the tissue around the eye, causing the above-mentioned symptoms. Many people with TED also suffer from Graves’ disease (although they are separate conditions), which affects the production of hormones within the thyroid gland.

What causes thyroid eye disease?

The definitive cause of thyroid eye disease is not yet fully understood, although it’s known to be an autoimmune disorder. This means there’s an imbalance within the body’s immune system whereby it acts abnormally, attacking the healthy tissues and cells in and around the eyes. 

Some factors that have been shown to influence the likelihood of developing the disease include: 

  • Genetics: Studies have shown that there is a hereditary component of developing TED. This means that your risk is increased if you have a family member who suffers.
  • Environmental factors: By far the strongest influencer in developing TED and it’s severity is that of tobacco smoking. The level of smoking also increases the risk factor and symptoms. Giving up smoking, even if the disease is in the active stage, can dramatically reduce the symptoms and longevity.

Nutritional factors: A lack of various vitamins and minerals is shown to increase the incidences and severity of symptoms. In particular, Selenium and vitamin D deficiency appear to be a factor.

What eye diseases are there?

There are many different types of eye diseases. In addition to thyroid eye disease, some of the most commonly seen are: 

  • Glaucoma
  • Cataracts
  • Diabetic retinopathy
  • Strabismus
  • Age-related macular degeneration
  • Amblyopia
  • Uveitis
  • Conjunctivitis

How to reduce swelling from thyroid eye disease

There are various ways to reduce swelling. Depending on the severity these can include: 

  • Sleeping with your head in an elevated position 
  • Wearing sunglasses
  • Giving up smoking
  • Taking Selenium supplements
  • Restricting salt in your diet
  • Taking diuretic medication
  • Following stress reduction techniques
  • Corticosteroid therapy
  • Orbital radiotherapy
  • Orbital decompression surgery

How to treat thyroid eye disease

Thyroid eye disease is treated by two medical specialists: an endocrinologist and a specialist ophthalmologist (eye doctor). Together they work to treat both the symptoms and the cause. You may be prescribed drugs to regulate the hormone production of the thyroid gland, and the eyes will be treated depending on the severity of your symptoms. 

Options available for treatment range from lifestyle and environmental factors (giving up smoking, reducing salt in your diet, sleeping with your head raised) to drug therapy (steroids, diuretics), radiotherapy, and surgical procedures.

Treatment will be ongoing and will evolve as the disease progresses. In some cases, and if surgery is deemed appropriate, this is only carried out once the condition has settled into stage 2—the stable phase—which tends to be any time from 1-3 years from onset.