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Thyroid Ophthalmopathy

Overview

Thyroid ophthalmopathy is an autoimmune disease that affects muscles and tissues around the eyes. This disease is also known as Graves’ ophthalmopathy, thyroid eye disease, thyroid-associated ophthalmopathy and thyroid-associated orbitopathy.

Thyroid ophthalmopathy is caused by a malfunctioning immune system, which attacks the tissues surrounding the eyes and causes inflammation. This condition occurs most often in people who have Graves’ disease, an autoimmune disease that causes the thyroid gland to produce too much thyroid hormone. Many cases of thyroid ophthalmopathy are mild, and a variety of conservative and surgical treatment options are available.

Symptoms

  • Bulging eyes
  • Difficulty moving the eyes
  • Double vision
  • Dry, scratchy or watery eyes
  • Eye pain or pressure
  • Sensitivity to light
  • Swollen eyelids
  • Redness in the white part of the eyeball

When thyroid ophthalmopathy is advanced, sores on the cornea may develop. This is called corneal ulceration. These ulcers can make it difficult to fully close the eye.

Prevention

  • Thyroid ophthalmopathy cannot be prevented.
  • Smoking and radioactive iodine therapy can make thyroid ophthalmopathy worse. Radioactive iodine therapy is a common treatment for hyperthyroidism (overactive thyroid), which may be caused by Graves’ disease.

Risk Factors

  • Thyroid ophthalmopathy cannot be prevented.
  • Smoking and radioactive iodine therapy can make thyroid ophthalmopathy worse. Radioactive iodine therapy is a common treatment for hyperthyroidism (overactive thyroid), which may be caused by Graves’ disease.
  • Graves’ disease
  • Hashimoto’s thyroiditis, which is inflammation of the thyroid gland that can cause hypothyroidism (underactive thyroid)
  • Smoking
  • Secondhand smoke
  • Diagnosis

    • Medical history. Your physician will ask about any medical conditions you have, especially any history of Graves’ disease, Hashimoto’s thyroiditis, or over- or underactive thyroid. He or she will also want to hear about your symptoms.
    • Physical examination. Your physician will look for physical clues of thyroid ophthalmopathy, such as protruding eyes and puffy eyelids.
    • Imaging exams. A CT or MRI scan can help your physician find signs of thyroid ophthalmopathy, such as excess orbital fat (fat in the eye socket, or orbit) and enlarged muscles around the eye.
  • Treatment

    • Eye drops. Dry eye is one of the most common symptoms of thyroid ophthalmopathy. Lubricating the eyes with eye drops may help. You can also apply cool compresses to moisten the eyes.
    • Elevating your head during sleep. Use extra pillows to raise your head above your body in bed, which can decrease eye swelling. Alternatively, use blocks to elevate the head of your bed.
    • Sunglasses. Your eyes may be more sensitive to sunlight. Wearing sunglasses can reduce discomfort.
    • Prism correction. Wearing eyeglasses with prisms may reduce or eliminate double vision. The prisms orient double images into a single one.
    • Medications. These include steroids to treat swelling and drugs to calm the body’s overactive immune response.
    • Surgery. Your physician may recommend a multi-stage surgical treatment, depending on the severity of your symptoms. First, he or she will perform orbital decompression surgery to remove bone and fat in the orbit. This procedure may improve vision by creating more room for swollen muscles and tissues. Next comes surgery to reposition certain eye muscles to eliminate double vision. The final step is a procedure to shift the position of the eyelids to help them close more effectively.
    • Radiation therapy. This may help reduce inflammation around the eye, but it’s an uncommon treatment option.    
  • Follow-up Care

    • Be sure to take all medications as prescribed and follow your physician’s recommendations closely, especially those relating to potential activity restrictions following surgery. You may notice light bruising or swelling after surgery, but it should disappear within two weeks. Notify your physician if you develop any signs of infection after surgery.
    • Keep all follow-up appointments with your physician.
    • Notify your physician if you notice any new symptoms or your condition worsens.