Thyroid Eye Disease || Eye problems associated with thyroid disease
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Thyroid eye disease (Orbitopathy)


Thyroid Eye Disease


Patients with thyroid disease particularly those with hyperthyroidism / Graves's disease may experience eye symptoms like watering, gritty, sandy sensation or feeling of pressure behind the eyes. In severe cases the eye balls may bulge out and become prominent. This can be associated with intolerance to bright light (photophobia), blurring of vision, double vision, redness and excessive watering of eyes. Sometimes the patient may experience decreased brightness of colors due to pressure on the optic nerve.

Most commonly however the staring appearance or bulging of eyeballs is what makes a patient to seek help. If the eyelids don't close completely the cornea is at risk of damage due to dirt, dust, dryness which can ultimately lead to blindness.

How to detect and diagnose?

If you have been recently diagnosed with hyperthyroidism then the diagnosis is straight forward in severe cases. If you have mild symptoms mentioned above then do tell your doctor about it. This can help in early diagnosis.

Thyroid associated Orbitopathy

Thyroid associated Orbitopathy

Usually both the eyes are involved although single eye can be affected. In such causes other than thyroid has to be considered.

Sometimes the patient may have no thyroid abnormality whatsoever but has only eye problem mentioned above. In such cases your doctor may order several tests to confirm the diagnosis and rule out the possibility of other diseases like tumors in the eye socket.

How to know the severity of the eye disease?

Thyroid associated Eye disease might be mild due to effect of excess thyroid hormones or it can be more severe in patients with graves disease. Your doctor makes an objective assessment of the severity and whether the disease is active currently by using scoring systems. This assessment may require examining your eyes and a variety of tests like Ultrasound or CT scan, measuring intraocular (eye) pressure, Blood tests for thyroid antibodies and so on.

What is the natural course of the eye disease?

Eye disease associated with Graves' hyperthyroidism worsens for a few months initially and then levels off. It can stay static for a long time and then starts improving. Of course the course can be altered by the medicines given foe the hyperthyroidism. These medicines in correct dosage can cause improvement of the eye problem and in improper doses can rarely cause worsening too.

Radioactive iodine and Thyroid Eye disease..

It is a very controversial topic on which many experts differ in their opinion. In general it may be noted that worsening of eye disease can be a problem, when the eye disease is already advanced and severe. Continuing smoking cigarettes can cause real trouble. In borderline cases steroid treatment can help in preventing worsening.

What are treatment options available?

Treatment is planned in consultation with an ophthalmologist with special interest in thyroid associated orbitopathy. Mild cases may need nothing more than moisturising eye drops and lid protection, while severe and active cases may require high dose steroid injections, surgery or even radiation treatment to save the eye. Once the disease has burnt out surgery may be needed to correct the remaining deformities/abnormalities (e.g double vision).

In conclusion treatment for thyroid associated eye disease requires a coordinated approach including establishing the priorities for both the patient and the treating doctor.