ΑρχικήThyroid Eye Disease

Thyroid Eye Disease

There are many names one encounters for this autoimmune disease of the eye, in the context of thyroid disease. Thyroid disease of the eye, Graves’s eye disease, Graves’s orbital disease, Thyroid orbital disease describe the same disease.

While this is different from Thyroid Disease, it is often found in combination with it. Thyroid orbiculopathy may be present in individuals without any apparent thyroid dysfunction, and may occasionally occur in patients with Hashimoto’s disease. Most patients with a thyroid problem will not develop thyroid disease of the eye/orbit, but if they do, it will be mild.

What are the symptoms of Thyroid Orbitopathy?

– Pain in the eyes, especially when looking up or sideways
– Irritated dry eyes
– Swollen eyes
– Eye or wild look, due to pressure of swollen tissues pushing the eye outward
– Red eyes
– Double vision or double vision (image with image)
– Loss of vision

What is the therapy for Thyroid Orbital Disease?

Treatment, in mild cases of thyroid eye disease, is drops of artificial tears, where caution is needed because not all are the same, or ointment, to treat the symptoms of dry eye.
In case of pain or swelling, a short steroid treatment is sufficient. Orbital radiation is an alternative in some patients.
Patients with thyroid eye disease require frequent monitoring due to the risk of developing compressive optic neuropathy, which can occur in a small percentage of patients.
In this case, the swelling of the orbital tissues can compress the optic nerve, which is responsible for vision, and cause permanent blindness to the patient. For these patients, orbital decompression is required to prevent vision loss.
Orbital decompression may also be required in patients who have severe eye prolapse (exophthalmos).
Patients who complain of double vision can wear glasses with prism or be surgically corrected. The disease can cause lifting of the upper eyelids and create a fierce or intense look. This can be surgically corrected by surgery on the eyelids.

An essential element of any surgical procedure, especially cosmetic surgery, is providing the patient with sufficient time for information.

More detailed information for patients

When Graves disease affects the eyes it is called an eye disease called Graves. If you have Graves eye disease, your eyes may look out, or appear red and swollen, and the distance between the upper and lower eyelid may be greater, which gives the impression that your eyes have grown. Excessive tears and irritation may also appear in both eyes. You may have sensitivity to light (photophobia), blurred or double vision, inflammation or reduction of eye movements. You may also have a feeling that something is pulling you to the extreme positions of the gaze.
In Graves’s eye disease, the eye projects beyond the orbit that protects it, because the tissues behind the eye retain water.

When this happens, the tissues, fat, and muscles swell, pushing the eye forward. So it projects more than in the past (creation of exophthalmos). The front side of the eye may dry out.
Eye symptoms usually appear within 18 months of the symptoms of hyperthyroidism. But there are cases where there may be symptoms in the eyes without symptoms of hyperthyroidism.
The treatment recommended for Graves’s eye disease is based on the individual patient’s symptoms. Sometimes, combinations of treatments may be needed.

The doctor may recommend:
· Cold compresses, sunglasses, artificial tear drops.
· Sleep with three pillows so that the head is higher than the rest of the body.
· Medicines or radiation to swell the tissues in front around and behind the eye.
· Orbital decompression surgery.
· Prisms for your glasses in case of double vision.
· Surgery on the eye muscles, surgery on the eyelids, blepharoplasty or all of the above.

Steroids and Orbital Radiation

Tissue swelling behind the eyeball may be reduced by treatment with corticosteroids (cortisone pills or intravenous administration of hydrocortisone). If steroids prove ineffective, radiation to the orbit is recommended. Treatments are usually given twice a week with a total dose of 2000 rads. The radiation in the orbit does not require hospitalization.

Why choose Dr. Trakos?

Dr. Trakos’ contribution to the field of anterior segment and cataract surgery, as well as to the treatment of vision problems, has changed the lives of many people by improving their sight and quality of life

Orbital decompression surgery

In orbital decompression surgery, the bone between the orbit and paranasal niches (areas filled with air next to the orbit) is removed.
Successful surgery improves vision and gives enough space to your eye to return back to the orbit, which protects it.
Complications that can arise from this surgery can be reported.
You may have a decrease in the sensation of the eyelid or cheek after surgery which may slowly return.
The diplopia you have had may persist, even if it is reduced or may increase or even appear for the first time after surgery. It may take prisms in your glasses or surgery on the muscles of the eye to treat the above symptom of diplopia.
Loss of cerebrospinal fluid which is a very rare complication of surgery and can be restored intraoperative or postoperative.
Recovery from this surgery usually begins with the stay overnight in the center where you will be hospitalized.
You will be scheduled for a follow-up visit at 7-10 days and again about 6 weeks after you leave the center.

Prisms

Your ophthalmologist can prescribe prisms for your glasses to correct double vision. Prisms can be temporary or permanent on your glasses. However, prisms do not work for all people with diplopia. Sometimes the surgery of the muscles that move the eye is the most effective treatment.

Surgery of the eye muscles (strabismus surgery)

Diplopia (a sense of double vision) usually occurs because your eyes are not aligned. Misalignment of one eye with the other is often caused by one or more eye muscles that are too tight due to scar tissue from Graves’ eye disease. This scar tissue is a result of inflammation and swelling that occurs in the eye and around the eye.
The goal of strabismus surgery is to prevent the patient from seeing double when looking straight and when reading. When the patient looks over or in the extreme eye position there may still be some amount of diplopia after the operation. During strabismus surgery, the muscle is detached from its adhesion to the bulb and reattached a little further back. Typically, strabismus surgery does not require hospitalization overnight. The results are reassessed about two months later. Sometimes you may need more than one operation. If orbital decompression surgery and strabismus surgery are required, then orbital decompression surgery will be performed first, followed by strabismus surgery approximately 6 weeks later.

Eyelid surgery

Graves’s eye disease generally makes the eyelids open more than they should. Some patients have difficulty closing their eyes. The anterior surface of the eye is exposed excessively, without being able to be covered by the eyelid, causing excessive tears and discomfort. Surgically, eyelid correction can reduce irritation.
If you will need surgical decompression of the orbit, strabismus surgery and eyelid surgery, the surgery that concerns the eyelids is done last, after the other operations.
While Graves’ disease can affect vision and appearance by causing a whole series of problems, many of the symptoms can be successfully treated. Dr Trakos will help you decide on the right treatment plan or an effective monitoring plan.