Both inflammation and build up of fluid around the eyes can cause them to protrude (exophthalmos) and have an exaggeratedly wide-open appearance with Thyroid Eye Disease (TED), also referred to as "thyroid orbitopathy". The eyeball can also move forward from its position within the eye socket which can become severe in some cases (proptosis). Patients with TED can experience dryness, redness and irritation within their eyes. A feeling of pressure and grittiness in the eyes can also occur, as well as difficulty with fully closing the eyelids. Treatments are available for this condition associated with cases of thyroid autoimmunity (diseases caused by thyroid antibodies).
Graves’ Ophthalmopathy
Medical sources state that Graves’ Ophthalmopathy is clinically apparent to varied degrees in up to 50% of Graves’ disease patients, although other medical sources state that up to 80% of Graves’ patients experience some type of eye symptoms as listed previously. While Graves’ is the autoimmune cause of thyrotoxicity, also referred to as “hyperthyroidism” TED can occur in approximately 10% of patients with the auto-antibodies that cause Grave’s but whose thyroid hormone levels are euthyroid, meaning within normal values. Only about 2% of Hashimoto’s thyroiditis patients (those with autoimmune hypothyroidism) are affected by TED.
Optic Neuropathy
The optic nerves in the eyes of TED patients can also become affected due to their becoming compressed as a result of pressure from tissue-swelling in and around the eyeballs (orbital areas). With this condition that can be present with TED, a patient may experience pain, inability to see colors and/or partial loss of vision which will affect one or both eyes. Nerve cell damage may occur with optic neuropathy and eventual blindness is possible if treatment for TED is delayed.
The Role of Myxedema in TED
Myxedema is a term meaning tissues in the body are retaining fluid (edema) and a build-up of mucin (mucus) will cause a thickening of the skin in areas of the body, or what is also referred to as “pretibial mucinosis”. The condition is often present in autoimmune thyroid disease patients who are experiencing TED. Areas on the face can become swollen for example and will have a puffy appearance. The deep tissues around the eyes can also become swollen as well as tissues behind the eyes. This causes less area in the eye-sockets for movement and to retain the orbital position of the eyes, causing them to be pushed forward and to protrude.
Treatments for TED
The first line of treatment when TED is diagnosed is to correct any thyroid hormone imbalance that might be present if it is not already being done. In cases when thyroid autoimmunity is the cause of hyperthyroidism, patients may need to have their thyroid glands removed. Some medical research studies state that surgical removal of the gland (thyroidectomy) may be a better choice than destruction of the gland by radioactive iodine (ablation) because of the risk the latter mentioned procedure may present to some patients with TED, in worsening the condition. The following list of treatments may also be administered individually or in combination as determined by a treating physician.
- Prescription eye drops for added lubrication to help prevent dryness and redness.
- Corticosteroid (cortical steroid) and/or topical hydrocortisone to reduce inflammation in the eyes and in tissues surrounding the eyes.
- Radiotherapy or Decompression Surgery (possibly both) to reduce pressure in the eyeballs and to prevent potential damage to them.
- Surgery for lengthening the eyelids that do not fully cover the eyes due to protrusion of them.
- TED patients who are smokers can benefit by quitting due to chemicals in cigarettes that cause inflammation in the eyes and may also be a recommendation by their doctors.
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