WHAT IS THYROID EYE DISEASE?

  • Autoimmune inflammatory condition of the eye socket.
  • Also known as Graves’ Orbitopathy (GO).
  • Affects muscles and fatty tissue behind the eyes, causing swelling, redness, and inflammation.
  • Symptoms range from gritty, swollen eyes to vision impairment and facial disfigurement.
  • Effective medical and surgical treatments available for various stages and types of TED.
  • Example: Mixed changes in a patient with left upper lid retraction, eyelid fullness, and disordered eye movements causing double vision.
  • Debilitating symptoms: Double vision due to scarred eye muscles preventing proper movement.
  • Typical features: Proptosis (bulging eyes), upper eyelid retraction, and an 'angry' or
    ‘surprised’ look.

CAUSES OF THYROID EYE DISEASE

  • Commonly caused by hyperthyroidism associated with Graves' disease.
  • Can occur in other contexts.
  • Incidence: Approximately 19 per 10,000 people.
  • Affects any age group, most frequently working-age women.
  • Can affect patients during pregnancy.

THYROID EYE DISEASE SYMPTOMS

  • Early stages often misdiagnosed as allergic eye disease, hay fever, or dry eye.
  • Specialist expertise needed for accurate diagnosis.

Symptoms depend on severity:

Common milder symptoms:

  • Ocular irritation
  • Swelling around the eyes

Severe symptoms:

  • Eye grittiness
  • Swelling in upper eyelids
  • Eye bags
  • Redness of eyelids
  • Sensitivity to light
  • Blurred or double vision
  • Dry or watery eyes
  • Bulging eyes (staring look)
  • Pain and discomfort
  • Difficulty moving eyes
  • Sight loss

Most severe symptoms:

  • Threatens vision
  • Blindness due to optic nerve compression
  • Inability to close eyes, leading to corneal exposure

HOW IS TED DIAGNOSED?

  • People with thyroid problems should be aware of TED.
  • GP should explain symptoms and refer to a specialist ophthalmologist.
  • Diagnosis through comprehensive eye examination, specialised blood tests, and orbit scans (CT or MRI).

Factors requiring consideration:

  • Thyroid hormone control
  • Accurate ophthalmic assessment
  • Orbital imaging review
  • Medication and immunosuppression management
  • Surgery selection

STAGES OF THYROID EYE DISEASE

  • Two phases: Active phase and inactive phase.

Early active phase:

  • Disease progresses actively, lasting six months to two years.
  • Characterized by inflammation and eye surface dryness.
  • Symptoms: Burning sensation, dull ache worsened by eye movement.
  • Treatment: Lubrication, liquid teardrops, wrap-around sunglasses, avoiding
    extreme temperatures.

Inactive or chronic phase:

  • TED has "burnt out."
  • Possible changes in appearance and double vision.
  • Treatment: Surgical procedures like orbital decompression, eyelid lowering, blepharoplasty.