Thyroid Eye Disease: What You Need To Know

What Is Thyroid Eye Disease?

Thyroid Eye Disease (TED) is a condition in which the eye muscles, eyelids, tear glands and fatty tissues behind the eye become inflamed. This can cause the eyes as well as the eyelids to become red, swollen and uncomfortable.

Also known as Graves’ Orbitopathy or Ophthalmopathy, thyroid eye disease is an autoimmune condition. It occurs when the body’s immune system attacks the tissue around and behind the eye, causing inflammation in the tissues. In some cases, there is swelling and stiffness of the muscles that move the eyes so that they no longer move in line with each other; this can cause double vision.

TED is most commonly associated with Graves' disease, an autoimmune condition that causes an overactive thyroid gland. Data suggests that about 300,000 people in the UK struggle with TED.

Symptoms Of Thyroid Eye Disease

The way that TED affects the eyes varies between different people. Troubling signs of this eye condition would usually affect both eyes at the same time.

Symptoms of TED include:

1. Bulging eyes (proptosis)
2. Dry, gritty and irritated eyes
3. Red eyes
4. Puffy eyelids
5. Sensitivity to light
6. Watery eyes.

In more advanced cases of TED, patients may also experience:

1. Trouble moving eyes and fully closing eyelids
2. Corneal ulcers caused by an inability to completely close eyelids
3. Colours that appear to be dull or not as bright
4. Blurred or loss of vision due to optic nerve compression or corneal damage.

Risk Factors For Thyroid Eye Disease

Over the past few years, researchers have identified a number of factors that increase the risk of developing TED. These include:

1. Smoking: Cigarette smoking is the strongest modifiable risk factor for TED. In smokers with TED, as compared with non-smokers, severe disease is more likely to develop and less likely to respond well to immunosuppressive therapies.
2. Graves’ disease: This is an autoimmune condition where your immune system creates antibodies called thyroid-stimulating immunoglobulins (TSIs). They mimic thyroid-stimulating hormones (TSHs), and trick the thyroid gland into producing more hormones than is necessary.
3. Fluctuations in thyroid hormone levels: These fluctuations can rapidly worsen TED. It’s therefore important to keep your thyroid hormone levels at the correct levels. Make sure you have thyroid blood tests regularly and follow the advice given by your doctor about when and how to take your thyroid medication.
4. Radioiodine treatment: If the thyroid gland is very overactive, radioactive iodine treatment can cause dangerously high levels of thyroid hormone and, very rarely, a condition known as thyroid crisis. This treatment can also aggravate TED in smokers.

Treatment Options

A recent study found that patients with thyroid eye disease (TED) are at an increased risk of developing depression and anxiety. These individuals may also experience diminished self-confidence, reduced social engagement, and challenges with productivity in both work and academic settings.

TED can change your facial appearance and alter your expression. This may affect the way people react to you which, understandably, can be difficult to cope with. That’s where treatment comes in.

During the active stage of TED, treatments are aimed at ameliorating your symptoms and protecting your eyes while the condition runs its course. Symptoms fluctuate during the active stage, which can last for months or a couple of years. People with TED should be jointly looked after by an ophthalmologist and an endocrinologist (a doctor who diagnoses and treats hormone-related problems).

Common treatment methods deployed to cushion the harsh effects of TED include:

1. Lubrication: The use of lubricating eye drops, also known as artificial tears, can help to make your eyes feel more comfortable. They can also help to prevent your cornea from damage caused by dryness. Thicker gel type drops can be used to help lubricate the eyes for longer. Ointments can help lubricate the eyes overnight.
2. Prisms: These work by bending light in a direction which compensates for the angle between the eyes. They can be tailored to match the angle between your eyes and fixed to spectacles. Temporary stick-on prisms, known as ‘Fresnel’ prisms, may be used until the angle is stable. Once the angle is stable, prisms can be incorporated into your normal spectacles by an optometrist.
3. Selenium supplements: Research suggests that taking selenium supplements (200 micrograms daily) for 6 months may help people with mild, active thyroid eye disease. It’s important to check with your doctor whether taking supplements is safe for you, especially if you are taking other medications as well.
4. Steroids: TED involves tissue damage caused by inflammation in and around the eyes. The goal of steroid treatment is to control that inflammation and stop acute damage.
5. Decompression surgery: Orbital decompression is a surgical procedure aimed at increasing the orbital volume and/or decreasing the volume of the orbital fat. It can be performed in both the active and non-active stages of the disease. This surgery relieves the pressure on the optic nerve by making the eye socket larger or taking away excess tissue.
6. Eye muscle surgery: The damage from active TED can cause scar tissue to build up on your eye muscles. Scar tissue can shorten eye muscles and limit movement of the eye, resulting in misalignment. Eye muscle surgery fixes this. During the procedure, a surgeon cuts damaged muscles, then reattaches them to your eye. This returns your eyes to their correct position and restores a normal range of movement.
7. Eyelid surgery: Tight eyelids keep your top eyelid from coming down and your bottom lid from coming up. This can lead to corneal damage. Eyelid surgery makes it easier to keep your cornea covered.

Thyroid eye disease is a challenging autoimmune condition that impacts vision, appearance, and quality of life. Understanding its symptoms, risk factors, and treatment options is essential for effective management. Early detection, lifestyle changes, and collaboration with healthcare specialists can significantly improve outcomes.

If you have any questions regarding eye care at Optimax, please don’t hesitate to get in touch with us. We are more than happy to discuss queries with you over the phone (0800 093 1110) or email (enquiry@optimax.co.uk).