Choose the content to read

• What are the Initial symptoms of thyroid eye disease?
• What are the causes of thyroid eye disease?
• What are the dangers of untreated thyroid eye disease?
• What are the critical symptoms of thyroid eye disease requiring immediate medical attention?
• When is thyroid eye disease most dangerous?
• Can the bulging eyes retreat after the disease goes into remission?
• What are the factors triggering thyroid eye disease symptoms?
• How is thyroid eye disease diagnosed?
• How is thyroid eye disease treated?
• Surgical treatment for thyroid eye disease

Thyroid Eye Disease

Thyroid eye disease (TED) is a condition secondary to autoimmunity, which stimulates the thyroid gland to overproduce its hormones. Elevated thyroid hormones impact the function of various organ systems, including the visual system, leading to a condition commonly known as thyroid eye disease. We summarize essential and helpful information from experienced ophthalmologists specializing in treating thyroid eye disease. Keep reading to learn about this condition, how to recognize it, and the dangers if not promptly treated.

What does a normal eye look like, and what are its components?

In a normal state, the eye resides within the bony structure called an eye socket (or the orbit) and does not bulge out. The eye socket contains fat that cushions the eye, muscles that facilitate eye movement, blood vessels that nourish it, and nerves that connect it to the brain. The outer end of the eye socket is wide while tapering toward the interior end, resembling a cone.

Are bulging eyes a sign of thyroid eye disease?

Bulging eyes (proptosis or exophthalmos) can indicate many abnormalities or severe conditions besides thyroid disease, such as lymphoma or vascular tumors. Bulging eyes indicative of thyroid eye disease are usually due to enlarged muscles and fat around the eyeball, pushing the eye forward. Sometimes, it may be secondary to a mass or fat behind the eye bulging it outward.

What are the Initial symptoms of thyroid eye disease?

The following are noticeable, initial symptoms of thyroid eye disease:

• Bulging eyes
• Retracted eyelids, wide-open eyes with a menacing look.
• Increased upper and lower sclera (white part of the eye) visibility.
• Double vision.
• Strabismus (misaligned eyes).
• Recurrent red eyes.
• Swollen conjunctiva.

In addition to the abovementioned symptoms, in severe cases, patients may experience reduced vision due to the enlarged muscles and fat pressing on the nerves, leading to decreased vision. The symptoms typically worsen over the first 1-2 years. If thyroid levels are under control, thyroid eye disease symptoms may stabilize or decrease, but it is unlikely to recover completely from this condition.

What are the causes of thyroid eye disease?

Thyroid eye disease is present in approximately 90% of patients with hyperthyroidism. It can also occur in patients with other thyroid conditions, such as thyroid cancer or autoimmune disorders like Hashimoto’s thyroiditis, or even in those with hypothyroidism.

What are the dangers of untreated thyroid eye disease?

Untreated, thyroid eye disease can worsen significantly within the first 1-2 years. Severe inflammation, extreme bulging of the eyes preventing proper eyelid closure, chronic corneal ulcers, and potential permanent vision loss due to nerve compression can occur. Patients with thyroid disease should promptly consult a specialist if they notice eye abnormalities for advice and timely treatment.

What are the critical symptoms of thyroid eye disease requiring immediate medical attention?

Severe thyroid eye diseases necessitating immediate medical consultation include:

• Blurred vision is potentially due to nerve compression, which can lead to permanent vision loss.
• Increased bulging of the eyes can lead to the inability to close them, risking corneal ulcers and permanent vision loss.
• Double vision, caused by enlarged eye muscles, makes daily activities difficult or impossible.

When is thyroid eye disease most dangerous?

The most severe symptoms of thyroid eye disease occur in the first 1-2 years. During this period, symptoms progressively worsen but early treatment can reduce the risk of vision loss.

Smoking exacerbates the severity and duration of the disease, potentially extending the severe period from 1-2 years to 3-4 years and increasing the risk of permanent vision loss.

Can the bulging eyes retreat after the disease goes into remission?

During remission, eye symptoms slowly improve. Complete recovery to normal is rare, but 30-50% improvement is typical. Further correction often requires surgery to address residual abnormalities.

What are the factors triggering thyroid eye disease symptoms?

Key factors triggering thyroid eye disease symptoms include:

• Smoking worsens eye symptoms.
• Inadequate rest can exacerbate the disease. Having adequate rest, as well as consuming nutritious diets, can help prevent the rapid progression of the disease.
• High hormone levels can exacerbate the disease. Keeping the hormone levels under control helps prevent eye symptoms from worsening.

How thyroid eye disease diagnosed?

• Physical examination to assess eye abnormalitie.s
• Blood tests and immune tests, such as the anti-TSH receptor antibody test and thyroid hormone levels, if not tested previously.
• CT scan of the eye socket to check for abnormal muscle enlargement or fat deposits indicative of thyroid eye disease.

How is thyroid eye disease treated?

Treatments of thyroid eye disease vary depending on the two phases of the condition:

• The first phase, lasting 1-2 years, is the active phase with ongoing inflammation. If swelling, bulging eyes, and double vision worsen during this period, steroids may be necessary to reduce inflammation and control the enlargement of affected muscles and fat deposits.
• The second phase is when the disease has stabilized after 1-2 years of the first phase. During this phase, it is crucial to assess for any residual eye symptoms. Surgery may be necessary, with orbital decompression surgery considered first, followed by surgery to fix the muscles responsible for crowding the eye (strabismus surgery) if double vision persists. Lastly, the ophthalmologist will perform eyelid retraction corrective surgery to reverse the abnormal eyelid position.

Surgical treatment for thyroid eye disease

Although surgery can be performed on both eyes simultaneously, doctors recommend performing one procedure at a time. Before orbital surgery, it is crucial to keep thyroid hormone levels under control for a period, get adequate rest, eat healthily, and abstain from smoking and alcohol. Orbital surgery typically demands a minimum of 3 hours for each eye. Therefore, a hospital stay of 2-3 days is often necessary.

If you have concerns about thyroid eye disease or suspect that you have these abnormalities, do not hesitate to consult an ophthalmologist at the EYE Care Center at MedPark Hospital. The center, staffed with specialist doctors, is ready to provide every treatment process for thyroid eye disease, whether for the eye socket, eye muscles, or eyelids. Early detection and treatment can prevent damage and reduce the risk of permanent vision loss.