‘Thyroid eye disease is an autoimmune eye condition that can occur in those suffering from systemic thyroid disorder. However, even people with normal levels of thyroid can have this condition. The symptoms range from simple eyelid retraction to bulging of eyes with dryness and watering to serious problems such as severe pain, edema of the tissues around the eye, unable to close the eyes, limitation of eye movements, double vision, and loss of vision. The complaints are more in the morning hours and often fluctuate in severity over the days and weeks. Thyroid eye disease has an active and inactive phase. The active phase needs medical treatment, followed by the inactive phase when surgical treatment restores normal appearance. The condition can be quite frustrating for the patient and so it is important that people are vigilant about this condition and those having thyroid disorder get their eyes examined regularly to rule out eye related complications,’ says Dr Kavya M Bejjanki, Oculoplasty Consultant, Kode Venkatadri Chowdary Campus, L V Prasad Eye Institute, Vijayawada.
Thyroid eye disease: Thyroid disorder is an autoimmune condition where our protective mechanism attacks our own body. It can either result from hyperthyroidism, where our body releases too many thyroid hormones or hypothyroidism, where our body doesn’t release enough hormones. Both these types can result in thyroid eye disease. However, thyroid eye disease can also occur in people with normal levels of thyroid hormones. Thyroid eye disease has a peculiar course, which can be divided into two phases, as identified by eye specialists: The ‘Active’ phase is when the disease begins and usually lasts for 12-18 months when the maximum damage to the eye happens. Once the active phase ends, the patient enters the ‘inactive’ phase where the after-effects of the disease persist.
Who are at risk: Thyroid eye disease occurs more often in women and is commonly seen in the age group of 30-50, and the disease course is more severe after the age of 50. Chronic smokers, positive family history of thyroid eye disease and patients with high levels of stress are more vulnerable to developing thyroid eye disease.
Diagnosis: Thyroid eye disease is diagnosed by the clinical evaluation of the eye by the eye specialist, and they will order blood tests to check whether the thyroid hormone levels and antibodies are too high or too low. Imaging of the eye with computed tomography (CT scan) or magnetic resonance imaging (MRI) is advised as and when required.
Treatment:
- Active phase: It is a common myth that control of thyroid levels or treatment with steroids will reverse the thyroid eye disease, but it rarely does. Treatment in the active phase mainly comprises lubricating eye drops and steroids to reduce swelling. Simultaneously, the thyroid levels need to be controlled by consulting an endocrinologist if they are deranged. This active phase can be simply compared to a house on fire. While it is on flames, the fireman (doctor) concentrates on extinguishing the fire (immune swelling) with water or a fire extinguisher (steroids). One cannot think of rebuilding the house while the fire is still on! Medical treatment in the ‘active’ phase merely pushes the ‘fast-forward’ button, so that you arrive at the inactive phase early, to get an early surgical correction.
- Inactive phase: Most patients end up losing their ‘normal’ look and seek cosmetic correction of the eyes to restore their natural look. This inactive phase is the right time to perform surgeries to correct the deformity. The commonest surgery that is needed is a ‘key-hole decompression’. If you compare the eye socket to an ice cream cone and imagine the eyeball as an ice cream scoop, the decompression surgery widens this cone (through hidden incisions) to allow the eyeball (the scoop) to relax back into its natural position.
The L V Prasad Eye Institute at Vijayawada, Kode Venkatadri Chowdary Campus, offers comprehensive diagnostics, medical, and surgical services to treat thyroid eye disorders.