Thyroid Eye Disease
What Is Thyroid Eye Disease?

Thyroid eye disease (TED) is an eye condition related to thyroid disease. Patients with excessive thyroid hormone in the circulation (hyperthyroidism) can develop eye diseases and they may have any of the following symptoms:

  • Bulging or prominent eyes
  • Eyelid retraction (“staring appearance”)
  • Swelling of the eyelids
  • Frequent redness and tearing of the eyes
  • Dry eyes
  • Double vision due to swelling and stiffness of the eye muscles
  • Loss of vision from the compression of the optic nerve (rare but serious complication)
What Causes Thyroid Eye Disease?

Thyroid eye disease is part of an autoimmune disease that affects the tissues surrounding the eye. The body produces antibodies that attack its own tissues, specifically the fat around the eyes and the eye muscles. It can precede, coincide or follow the diagnosis of thyroid dysfunction of the rest of the body. It is known to be about 2.5-6x more common in women, however it is usually more severe when it occurs in a male.

Treatment Of Thyroid Eye Disease

The treatment depends on the severity and activity of the condition. The condition typically goes through a cycle of active phase followed by a quiescent phase which can span over 18 to 24 months from the time of the diagnosis.

If the condition is mild and the main symptoms are dry eyes, then copious and frequent lubricants will be prescribed. Should the condition be active and severe, the patient may require suppression of the immune system either with oral or intravenous steroids or other forms of immune suppression. Usually surgery is reserved for the more serious conditions, where there could be compression of the optic nerve and compromise of the vision, or severe exposure of the eyes from extreme protrusion of the eyes. Other forms of surgery may be needed if the double vision from tight muscles is persistent, or if eyelid surgery is required to lower the eyelid and reduce exposure of the eyes.

Socket Reconstruction

Patients who have lost the eye due to trauma or diseases such as tumors, may require socket reconstruction in order to restore some normality in the appearance of their eyes. This may involve replacement of the volume of the eyeball with a special ball implant, reconstruction of the surrounding supporting tissues of the eye with grafts and customized fitting of the prosthetic eye (false eye).

Some long-term problems that may arise in such patients include:

  • Discharge or discomfort from the wearing of the prosthesis (false eye)
  • Difficulty with retaining the prosthesis in the eye,
  • Progressive contracture of the supporting tissues surrounding the eye leading to a sunken deformity especially in the upper lid
  • In-turning of eyelashes from laxity and lack of support the lid structures

The management of these conditions depend on the nature and severity of the condition. A mild allergy or irritation from constant friction to the prosthesis can be treated with eyedrops while progressive shortening of the grooves between the eyelid and eyeball or ball implant or contracture of the surrounding tissues may require more extensive surgery to reconstruct the whole socket area.

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