THYROID EYE DISEASE (GRAVES’ DISEASE)
Approximately 30% of people with Graves’ disease show some signs and symptoms of thyroid eye disease. These signs and symptoms affect the muscles and fat around the eyes which can result in:
- Proptosis (Exophthalmos) – the eyes appear more prominent and bulge forward often beyond the bony orbital rim.
- Eyelid retraction – the upper eyelids rest too high and the lower eyelids rest too low on the eye, resulting in decreased protection provided by the natural lid.
- Lagophthalmos – eyes cannot close all the way.
- Dry Eye – with increased exposure to the environment, eyes are more likely to experience dryness and irritation.
- Tearing – can be caused by blockage of the tear duct (which is a potential side effect of radioactive iodine ablation) or by a change in the position of the tear duct opening in the eyelid.
Graves’ disease is an autoimmune condition. Seeing an endocrinologist for the management of thyroid hormone levels is important if you have been diagnosed with this condition. However, normalizing thyroid levels do not necessarily result in an improvement of the eye deformities caused by Graves’, which is why treatment from a restorative medical professional is sometimes needed.
THYROID EYE DISEASE TREATMENT
There is usually an active phase of thyroid eye disease when the deformities worsen. Eventually, the disease will plateau. If the disease causes enough swelling, it can compress the optic nerve, resulting in blindness if untreated. In this situation, strong anti-inflammatory medications may be given or emergent surgery performed to decompress the orbit.
Orbital decompression is performed in the operating room under general anesthesia. Bone is shaved from the orbit (eye socket) and excess orbital fat is removed to allow the eye to settle back into a natural position. Patients usually go home the same day as surgery.
If the vision has not been affected, the optimal time to treat thyroid eye disease is after it has passed the active phase and the deformities have stabilized for a minimum of six months. Mild symptoms may be managed conservatively with topical eye drops and lubricants. About 20% of patients may require surgical treatment. Surgery for thyroid eye disease is usually performed in steps, first treating the proptosis (eye bulging), any eye-motility problems (strabismus), and then treating issues such as eyelid retraction.