Thyroid Ophthalmology

What is thyroid ophthalmopathy?

Thyroid ophthalmopathy also known as thyroid orbitopathy, Gaves-basedow endocrine ophthalmology exophthalmos or thyroid eye disease, is an involvement of the ocular orbit that is associated with an autoimmune disease of the thyroid gland.

As an autoimmune disorder, the immune system acts against some cells of the organism, in the case of thyroid ophthalmology, the immune system acts against tissues and structures around the eyes, such as the orbital fat, the muscles in charge of eye movement or the eyelids themselves.

It is believed that one in six people with thyroid problems have thyroid orbitopathy.

Prognosis of thyroid ophthalmopathy

The disease may have a different course in each patient. As a general rule, orbital disease has a more positive prognosis in young women, and is most severe in men and women over the age of 50.

Early diagnosis of eye and thyroid disease improves the prognosis, since the earlier the problem is addressed, the better the treatment responds. In fact, it is of vital importance that in the first weeks of the eye disease – in which eyelid edema, tearing, blurred vision, chronic conjunctivitis… appear – the patient is examined by a specialist and an endocrinologist, although in the first months the hormone analyses may be completely normal.

Habits such as smoking worsen the prognosis, responding worse to treatment.

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The most serious complication of this disease is the loss of vision due to compression of the optic nerve muscles. Corneal ulceration is another of the most severe complications, which can lead to ocular perforation, and surgery is a priority.

It is common for patients to suffer depression due to the physical changes that occur in their eyes, although these can be corrected once thyroid function is stabilized.

Symptoms of thyroid ophthalmopathy

Initially, thyroid ophthalmology usually begins with a phase of active inflammation, which varies in duration from six to twelve months. Once the first phase is over, a stable phase is entered, in which the inflammation weakens and subsides. However, the inflammatory phase of the disease occurs with the onset of hyperthyroidism, although sometimes ophthalmopathy may appear before or after thyroid disease.

Although the severity levels of the disease vary greatly, photophobia, a sensation of the presence of a foreign body in the eyes, with irritation and red eyes including tearing, usually appears at the beginning. When the inflammation of the orbital tissues -fat and muscles- is greater, the size increases and exophthalmos, palpebral retraction and strabismus appear.

It should also be noted that, in some cases, thyroid ophthalmopathy may evolve differently from thyroid disease, progressing even if the thyroid is controlled.

Other symptoms may include double vision, exophthalmos (also known as bulging eyes), blurred vision, corneal injuries and even eye pain with movement.

Medical tests for thyroid ophthalmopathy

Various imaging tests help make the diagnosis as well as rule out other diseases or pathologies.

  • Ultrasound
  • Computed tomography
  • Magnetic resonance imaging
  • Thyroid-stimulating immunoglobulins
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What are the causes of thyroid ophthalmopathy?

Ophthalmopathy is related to endocrine alterations in the thyroid gland. In this case, we are talking about an autoimmune type disease, which can cause hyperthyroidism, a disease in which the thyroid gland becomes hyperproductive and generates an excess of thyroid hormone.

The cells attack the tissues surrounding the eye causing these structures to become inflamed.

Can thyroid ophthalmopathy be prevented?

There is no way to prevent thyroid orbitopathy. However, early diagnosis of a thyroid problem can allow better control and monitoring of the disease to detect problems early and avoid complications.

Treatments for thyroid ophthalmopathy

For treatment to be effective, it is important to stop smoking.

In case there is only palpebral retraction, i.e. eyes wide open, treatment is carried out with oral selenium supplements, together with artificial tears and moisturizing gel at night.

In case of moderate or severe ophthalmopathy, corticosteroids are also used.

With intravenous corticosteroid injection the effects of the disease improve from the first week, with rapid relief of symptoms.

If the disease is advanced and the exophthalmos is disproportionate, decompressive surgery may be chosen. This surgery increases the size of the orbit, allowing the eye to move backwards.

Which specialist treats thyroid ophthalmopathy?

The specialist in charge of treating thyroid ophthalmopathy is the Ophthalmologist and the Oculoplastic Surgeon. In case the patient suffers from self-esteem problems or depression due to the physical changes he/she will undergo, he/she can be helped by a psychologist.