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Thyroid Eye Disease

What is Thyroid Eye Disease?

Thyroid eye disease a rare autoimmune disease that can range in severity from mild eye irritation to a severely disfiguring inflammation that has the potential to cause blindness. For reasons that are not entirely understood patients with autoimmune thyroid disease (most commonly Grave’s disease) develop auto-antibodies that cause the body to attack the soft tissues (muscles and fat) inside the eye sockets. The fat cells in the eye socket can multiply (adipogenesis) and swell (from an accumulation of molecules known as glycosaminoglycans). The muscles that move the eye (extraocular muscles) and open the eyelids can grow in size and not work correctly, causing debilitating double vision (restrictive myopathy) and eyelid retraction (stare). The growth of the fat and muscles in the eye socket cause the eyes to protrude abnormally (proptosis or exophthalmos).

What are the Symptoms of Thyroid Eye Disease?

Patients will typically develop irritation on the surface of the eye with associated pain, foreign body sensation, discharge, and the feeling of dryness. A pressure sensation may be felt from the eye socket (orbit). Patients may notice redness, swelling around their eyelids and they may seem to have a staring expression. Double vision may develop and rarely, in the most severe form, patients may lose vision in one or both eyes.

How is Thyroid Eye Disease Treated?

Most patients who develop thyroid eye disease will require only supportive care. Artificial tears, cool compresses, and sleeping with the head elevated may help. In more severe cases the active form of the disease is treated with immunosuppressive medications (typically steroids) and sometimes low dose radiation treatments may be used. Routine examinations during the active phase of the disease are necessary to monitor disease progression and sight-threatening complications. Surgery is used in the inactive phase of the disease, typically 1-2 years after the onset of symptoms. Surgery may involve orbital decompression (expansion of the bony eye socket and removal of the orbital fat) to lessen proptosis, eye muscle surgery to straighten eye misalignment, and eyelid surgery to lessen eyelid stare and improve appearance.

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