Thyroid Eye Disease

Overview
Thyroid Eye Disease (TED), also known as, Thyroid Related Ophthalmopathy, Graves' Ophthalmopathy or Graves' Orbitopathy is an autoimmune disorder that occurs in people with thyroid dysfunction. Several of the symptoms associated with Thyroid Eye Disease are bulging eyes (proptosis) and or eyelid retraction, abnormal blinking, dry eyes, double vision (diplopia) or vision impairment and inflammation of the orbit and its surrounding tissues.  

Management of TED often requires special expertise in oculofacial surgery as well as access to a multidisciplinary team and tertiary care facility with specialized equipment.

What is Thyroid Eye Disease?
Thyroid Eye Disease is an autoimmune condition that can occur following thyroid disease. While most cases are related to a hyper-functioning thyroid (hyperthyroidism), TED can also occur in patients with normal thyroid (euthyroid) or under acting thyroids (hypothyroidism).

Ted occurs only in a small number of patients with Thyroid disease.  In many cases, the disease manifestation is mild and self-limited. In others, it manifests itself as swelling and inflammation of the tissues around the eye including the eye muscles and orbital fat.

What are the signs and symptoms of Thyroid Eye Disease?
Thyroid Eye Disease can present with decreased vision, redness, pain, tearing, dryness and swelling around the eye due to inflammation of the eye and surrounding tissues.  Also, inflammation and scarring of the eye muscles may occur, which may restrict eye movement, causing double vision.  When the inflammation is left untreated, it may compress the optic nerve causing progressive or permanent vision loss. Physical findings of TED include:

•    Bulging eyes (one or both eyes) also known as proptosis or exophthalmos
•    Double vision (diplopia)
•    Eyelid retraction (Von graefe's sign) or droopiness (ptosis)
•    Dry eyes (from decreased tear production or exposure of eye surface)

How is Thyroid Eye Disease treated?
Mild to moderate TED can be managed medically with topical regimens and oral medications.  If the disease progresses, then surgical treatment or radiation therapy may be necessary to prevent permanent visual impairment.
 
Surgical treatments may include decompression of the eye socket, management of the position of the eyelid or repositioning of the eye muscles.  If surgery is necessary, it is generally performed on an outpatient basis or a short hospital stay.

If you have been diagnosed with thyroid related eye disease and are experiencing any of the symptoms listed, it is important to seek out an expert to appropriately diagnose and manage your symptoms. 

Dr. Elahi's special interest in Thyroid Eye Disease has led him to lecture on the topic on a national and international basis.  He works closely with a team of endocrinologists, craniofacial surgeons, neurosurgeons, radiologists and radiation oncologists to effectively manage the disease and employ minimally invasive techniques when surgery is indicated.  These efforts have led to safer treatments with less scarring, and significantly faster recoveries.

Terms associated with Thyroid eye disease: Thyroid related ophthalmopathy, Thyrotoxicosis, Graves' ophthalmopathy, Thyroid related eye disease, proptosis, expophthalmos, Von Graefe's sign, exophthalmic goiter.