THYROID EYE DISEASE

The eye muscles can be influenced by the same processes that can affect the thyroid gland which is why thyroid gland imbalance is frequently associated with eye problems. The exact cause and effect relationships have not been worked out in detail yet.

Effects of Thyroid Eye Disease

1. Double vision (diplopia). The abnormal thyroid status alters the eye muscles that move the eye.

2. Proptosis (bulgy eye). Due to swelling of the muscles around the eye and of the fatty tissues around the eye.

3. Lid retraction. Due to excessive stimulation of a muscle in the upper lid by thyroid hormone.

4. Optic nerve compression. This is serious and potentially blinding. It is very rare. If you notice blur that is new or greying of vision or loss of colour in your vision (different to the other eye), you need to report this urgently.

5. Glaucoma. Raised pressure in the eye, which, if not treated, can after some years damage the vision.

Usual Expectations

Most cases of thyroid eye disease get worse over a year or two (or three) and then stabilise. A small number of cases can improve and a very small number improve dramatically. It is uncertain what effect thyroid function control has on the progress of the eye disease, but most doctors believe that it is important to have good control with blood tests etc.

SMOKING seems to make the eye disease worse. Radioactive iodine treatment which is necessary to control the thyroid dysfunction makes the eye disease worse in some patients (especially those who already have eye problems).

Photos Are Very Helpful

It helps me a lot to look at a series of photos of your face. Have someone take a close up frontal shot and also a close up of the left side and right side of your face. If there is any change in your appearance after, say 6 or 12 months, repeat the photos. Having a gallery of photos like this makes it easier to be accurate and precise about what is happening to the bulginess and lid retraction of thyroid eye disease in you.

Treatment

1. Double vision. This is initially treated with prisms that are ground into the spectacles or stuck onto the surface of spectacles (Fresnel prism). If these do not work we sometimes inject a muscle with a paralysing toxin (Botox); sometimes this is best done in the operating theatre. Botox has a useful effect about one case in four.When it is clear that matters are stable you can have surgery on the eye muscles if prisms are inadequate or not desired.

2. Proptosis. The best treatment for this is surgery. Oral steroids are sometimes used whilst waiting for surgery.

3. Eyelid retraction. Various drops are used to help irritation. Sometimes Botox is used. Eventually when everything is stable eyelid surgery may be required and the results are usually excellent.

4. Optic nerve compression. This is usually treated with surgery though steroids can sometimes be used whilst waiting for surgery.

5. Glaucoma. Eye drops are used. Sometimes surgery is performed to the eye muscles if the tightness of these muscles has produced the glaucoma.

An excellent website is that of the American National Graves Disease Foundation to be found at www.ngdf.org. Other websites include www.thyroid-fed.org/members/TED.html, www.btf-thyroid.org, and www.allthyroid.org.