Thyroid ophthalmopathy (or Graves eye disease) is an autoimmune, inflammatory disease of the and tissues around them. It is usually seen in patients with hyperthyroidism. However, it is sometimes also observed in patients with Hashimoto thyroiditis, which is the most common cause of hypothyroidism. “The thyroid is a gland in the anterior part of the neck, which produces hormones necessary to regulate metabolism and many other functions in the body. Thyroid ophthalmopathy develops when the immune system causes thyroid gland damage. These lesions are more common when thyroid hyperfunctions. DIVERSION Sometimes, however, they are also observed when it is under-operated or very rarely when it produces normal thyroid hormone levels. In all cases the immune system attacks the ocular muscles and tissues around the eyes,” says Dr. Anastasios-I. Kanellopoulos, MD, Surgeon- Ophthalmologist, founder and scientific director of the LaserVision Institute of Ophthalmology, Professor of Ophthalmology, University of New York. Thyroid diseases are very common. More than 12% of adults will experience some gland disorder at some point in their lives. Female patients are five to eight times more than men, mainly after pregnancy and menopause. However, although thyroid disease is so common, nearly 60% of patients do not know they suffer from it because they do not take preventive tests. CORVERSE Hyperthyroidism is one of the main thyroid diseases. It is estimated to affect 0.5% to 2% of the population. The most common cause of hyperthyroidism is Graves disease. Every woman has a 3% chance of developing it and every man 0.5%. The disease occurs more frequently at the age of 30 to 60 years. “Almost 40% of Graves disease sufferers develop thyroid ophthalmopathy either before, during or after their thyroid disease is diagnosed. The average age of development of eye disease is 40-45 years. In most cases ocular disease is mild. However, 5-6% of patients develop mild to severe thyroid ophthalmopathy,” points out Mr. If at the time of the diagnosis of Graves’ disease the patient is a non-smoker or former smoker, he has less than one in 10 chances of developing thyroid eye disease. But if he smokes a little or moderate, his chances double. And if he is a manic smoker (a pack of cigarettes or more a day), he has eight times as many chances as non-smokers to develop it. Thyroid ophthalmopathy is also more likely in those who have a family history of the same problem in the eyes, as well as those who have low levels of selenium in their bodies. Thyroid ophthalmopathy manifests with various symptoms, which may develop with exacerbations and depressions. One of the most common is to lift the eyelid. According to it, the upper eyelid is drawn upwards and the white part of the eye becomes more visible (as if the eye has “beaked”) when the patient looks at something that is right in front of him. Because thyroid eye disease also causes swelling (swelling) in the muscles in and around the eye, it can push forward the eye bulb. The result is the known exophthalmus (or eye prolapse from the eye sockets). Thyroid ophthalmopathy can also cause changes in vision, such as diplopia (the sufferer sees double idols, especially when looking at the side, as when looking at the side mirror in the car). The swelling may also increase the pressure inside the eye, causing damage to the optic nerve and a decrease in vision. Patients may also develop “bags” around their eyes, due to the swelling in their eyelids. Dry eyes are also very common because their eyes are more exposed to air and dust. This dry eye is often accompanied by a blurred vision and increased production of tears (dacrimation). There may also be intense sensitivity to light, reddening of eyelids and eyes, pain in or behind the eye (mainly when the sufferer looks up, down or sideways) and difficulty in eye movement. “If a patient has swollen eyelids and swollen skin around and under the eyes, and at the same time suffers from hypothyroidism, then he probably does not have thyroid eye disease. He simply needs treatment for his hypothyroidism and swelling in his eyes will retreat,” the professor explains. Treatment of thyroid eye disease depends on its gravity. Conservative and/or invasive treatments may be proposed in patients. The preservatives include artificial tears or lubricating ointments (to soothe dry eyes), sunglasses (for light sensitivity), cold patches (for relief of swelling and irritation) and cessation of smoking (affects symptoms in the eyes). Focus may also be prescribed for the patient’s glasses to correct diplopia. These prisms may be temporarily or permanently fixed to crystals. If the situation with these measures does not improve, if it gets worse or if eye disease is already moderate to severe, medication may be needed. Patients may, for example, be given steroids to reduce eyelid oedema. Or an intravenous infusion of special medicines that reduce symptoms and the need for surgery. “In severe cases, such as eyelid and eyelid retachment, surgical treatment may be needed to reposition eyelids or muscles of the eye or remove scar tissue or part of the eye joint. The operation can correct the appearance of the eyes, soothe dry eyes, improve vision and soothe pressure on the optic nerve, preventing the loss of vision. Early diagnosis and treatment can increase the success of the treatment to be done to the patient,” concludes Mr.
How thyroid diseases can affect the eyes
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