In this article we are going to discus about thyroid eye disease treatment. But before we do this, let’s first look at the definition of the disease. Thyroid eye disease is the problem of the soft tissues surrounding the eye such as the fat and the muscles. This condition causes the inflammation and engorgement of all the tissues of the orbit and makes them to become red and swollen. It is an auto-immune disease in which the thyroid gland is attacked by the white blood cells.
This problem occurs when the immune system experiences inappropriate behavior or auto –immune disorder. Instead of the system protecting the body by fighting off infections as usual, the anti-bodies begin to attack the body’s tissues, in this case the eye muscles and other connective tissues. The thyroid responds to the autoimmune attack by releasing excess amounts of thyroid hormones. But as the auto-antibodies continue to attack the thyroid gland, they as well attack the tissues surrounding the eyes and that is why the thyroid disease affects the eyes.
So autoimmune disease is the major problem affecting the thyroid and even causes thyroid cancer. This condition is associated with either an overactive thyroid gland (hyperthyroidism) or an underactive thyroid gland (hypothyroidism) which cause metabolism to either speed up or slow down.
Fast pulse or heartbeat, profuse sweating, palpitations, high blood pressure, weight loss, fatigue, irritability, heat intolerance, loss of hair and alterations in hair quality characterizes the state of hyper metabolism. On the other hand, hypothyroidism is characterized by bradycardia, dry skin, muscle cramps, weight gain, husky voice, drowsiness cold intolerance and poor mentation.
In most cases, it burns itself out while in its active inflamed stage after a period of time, usually about one or two years. But this is not without leaving behind enough dreadful effects from the disease (we’ll discuss about them later in the article). However, the disease may still lack any outward evidence of thyroid dysfunction even though it may be present.
Hyperthyroidism can cause ophthalmic conditions such as:
• Thyroid eye disease
• Thyroid-associated orbitopathy (TAO) also termed as Graves ophthalmopathy
• Graves eye disease
• Graves orbitopathy (TO)
The cause of the thyroid eye disease is not yet known. Though some say it may stem from a virus infection whose molecules tend to look to the body like the ones behind the eye. When the white cells and the antibodies try to get rid of them, they affect the cells behind the eye. Even after the virus has effectively been removed, the autoimmune reaction continues against the eye.
• Lid swelling (edema) – the eyelids and tissues around the eye become puffy and red.
• Lid retraction (constant stare) – The eyelid muscles contracts and produces a staring appearance.
• The muscles and fat surrounding the eye swell, pushing the eyes forward so that they bulge out of the orbits (exophthalmos).
• Lid retraction – the dry eye symptoms because they can’t blink properly and the glands producing tears are also affected.
• Bulging eyes – gives an appearance of a round-eyed stare
• Double vision or blurring (diplopia) – The swelling of the muscles causes unequal movements in the eye.
• Pain in the orbits during eye movement.
• Dry eyes, itchiness, or irritation of the eyes.
• Pressure in the eye sockets.
• Redness (bloodshot appearance in the eyes) and watering of the eyes.
• Eyes sensitivity to light
• Loss of vision or bad vision
The status of thyroids must be determined properly and checked whether the levels of thyroid hormones is low, normal or high before thyroid eye disease treatment can be done. But the eye condition may be treated depending on the severity of the disease. Treatment normally would include the following:
• The immunosuppressive drugs: These are the main treatment for the disease. These are the medications given to suppress the production of thyroid hormone. They are powerful steroids that deal with vision impairment and the inflammation around the eyes. Most of the time there is need for replacement of thyroid hormone because of the auto-immune attack or after successful treatment. This will ensure the function of thyroid returns to normal.
• Radiotherapy. For moderate to severe orbital inflammation, external beam radiation may be the main medical treatment. Usually 10 dosages of this are given for about 2 weeks. This is a medication for the tissues behind the eyeball.
• Orbital decompression surgery. This can be used to treat decompression that is in acute stage. This is medication for severe cases of swollen eye muscles by decompression. About 5% of the patients get this type of eye surgery. Surgery may also be used to improve residual function in inactive phase.
• Eyelid surgery: This is used in the case of grave ophthalmopathy where the eyelids open more widely. Surgery is performed on the eyelids to bring correction to this defect.
• Irritation, itchiness and redness of the eyes. In such a mild case of the disease, artificial or lubricating tear drops also called hypromellose or ointment for moisture can be used to attend to irritation of the eyes. Wrap-around sunglasses can be used to avoid the glare while humidifiers can be used to reduce the dry eye problem in the bedroom.
• Puffiness around the eyes. A water tablet may be used for this problem. Extra pillows may also help but generally the swelling should improve when the eye settles down.
• Staring eyes. If the problem is severe, surgery can be done; otherwise it should be able to settle down on its own.
• Double vision. This may not require treatment if it on occurs infrequently. Otherwise, it may need special glasses with prism lenses. Otherwise, the eye muscle surgery may be necessary to perform if the problem persists for long.
There are some side effects associated with some forms of thyroid eye disease treatment. Side effects associated with the use of steroids may include diabetes, weight gain, thinning of bones and skin. The patient must be monitored properly while using such medications.