Thyroid Eye Disease TED 101: Thyroid Disease Can Cause “Bug Eyes”.
Focus on Eyes: Thyroid dysfunction affects the eyes
Typical Graves’ Patient with bulging eyes red injected sclera.
- Thyroid eye disease, or Graves’ disease, usually occurs in patients with hyperthyroidism.
- It can also occur in patients with Hashimoto’s thyroiditis and hypothyroidism.
- Smoking has been associated with severe thyroid eye disease.
- Patients with thyroid eye disease have protruding eyes and eyelids can be retracted, thus leading to excessive dryness of the ocular surface.
- The eye muscles can be enlarged, which may lead to eye deviation.
- Rarely compression of the optic nerve (the nerve that transmits light information from the eye to the brain) causing decreased vision or even blindness.
- Ultrasound or orbital imaging (CT scan or MRI) can be used to visualize if the extraocular muscles are enlarged.
- Thyroid eye disease is usually self-limiting, lasting one to three years.
- Patients only require supportive care where lubrication plays an important part to prevent dry eyes, and they have routine monitoring.
- The acute inflammatory phase, patients require steroid treatment for improvement of symptoms.
- Some patients may benefit from orbital decompression (removing bones from the orbit) to decrease the amount of compression of the optic nerve by the enlarged muscles
- If patients have deviated eyes or complain of double vision, eye muscle surgery will be performed a few months after orbital decompression.
- If the patients need eyelid surgery to decrease exposure of the ocular surface or to improve cosmesis, this would be performed last.
- It is vital to avoid smoking since this can severely worsen thyroid eye disease.
- Most of my patients have Graves’ hyperthyroidism and develop TED and are treated with only my conservative method. 1. avoid smoking 2.smoky atmospheres 3.second or third hand smoke 4.artificial tears 5.cover the eyes during sleep ( Speedo swim goggles) tip have your significant other look at you while you sleep to see if your eyes completely close 6. Sunglasses with side panels 7. Elevate the head or the bed with blocks to overnight swelling Blocks from Bed Bath Beyond stores.
- When it is needed get to a eye surgeon with in treating TED. Many have no experience and should be avoided. Your local eye doctor is not the one to treat you.