Approximately one million Americans will be affected by thyroid eye disease each year. Most have a related condition known as Graves Disease. Thyroid eye disease refers to a specific immune system attack on the tissue and muscles surrounding the eyes. The condition, without appropriate treatment, can lead to vision loss. An experienced and knowledgeable surgeon like Jeffrey Schiller, MD, can offer treatment options that can improve comfort , vision and appearance, and in some cases prevent permanent vision loss.
What is Thyroid Eye Disease?
Thyroid disease is often the result of the body’s antibodies attacking the thyroid gland, resulting in hyper metabolism. The same antibodies may attack the muscles and fatty tissue around the eyes, resulting in thyroid eye disease. The swelling of the fatty tissues and muscles affects the eyes’ ability to move together, which can cause double vision. In severe cases, the swelling may displace the eye in the socket, causing bulging that makes it difficult or impossible for the eyelids to close fully, and leads to loss of the eye’s natural appearance. If left untreated, the condition may result in damage to other parts of the eye including the cornea and optic nerve, wth the possiblility of permanent vision loss if untreated.
Symptoms & Causes
Symptoms include a bulging appearance of the eyes as the muscle and fatty tissue in the eye socket swells, redness, and an inability to blink or close the eye lids. As the antibodies attack the lacrimal gland, which produces tears, dry eye or overwatering may result. Dryness, itching, redness, and discomfort may accompany thyroid eye disease. Women are more commonly affected than men, and smokers are more prone to developing the disease than non-smokers. Smokers also tend to exhibit more severe symptoms that last for a longer time than non-smokers.
Before and After Orbital Decompression Surgery.
Her bulging eyes have moved back into the orbit.
Types of Treatment
Various medications are used to treat thyroid disease, but thyroid eye disease often requires different treatment. If the swelling and inflammation become severe enough to compress the optic nerve or cause bulging, surgical intervention may be necessary to decompress the orbit and allow the eye to settle naturally into the socket. Jeffrey Schiller, MD specializes in reconstructive and cosmetic eyelid surgery and can help treat patients who suffer from thyroid eye disease. Call Dr. Schiller’s office today for a consultation if you are experiencing any of the abovementioned symptoms.
Scroll below to read Dr. Schiller’s patient information sheet on thyroid eye disease. Click here to see before and after photos of some of Dr. Schiller’s thyroid eye disease patients.?Click here for the International Thyroid Eye Disease Society.
Dr. Schiller’s information sheet for patients with Thyroid Eye Disease
Graves disease is an autoimmune disease. This means that the immune system that defends us from infections is attacking our own body. You may have heard of other diseases where the immune system attacks the patient’s own body. In rheumatoid arthritis, the white blood cells (immune system) attack the joints. In lupus, the lungs are attacked. In the commonest type of Graves disease the white blood cells attack the thyroid gland, releasing thyroid hormone. Testing the blood for the level of thyroid hormone confirms the diagnosis. This hormone affects many systems of the body.
In a small percentage of patients with Graves disease, the immune system also attacks the fat and muscles behind the eyes, causing
- inflammation of and around the eyes
- swelling of the upper and lower eyelids
- protruding (bulging) of the eyes
- pain around the eyes
- sometimes double vision
- rarely, loss of vision.
The inflammation usually lasts from six months to two years. The attack on the tissues behind the eye can happen before the thyroid is attacked, at the same time, or later. In most patients with Graves disease the immune system attacks only the thyroid and not the eyes. Graves eye disease is much more common in people who smoke or are around heavy smokers. In some patients the attack can be on the tissues behind the eye and not on the thyroid gland, so that the thyroid blood tests are negative. In that case the diagnosis is made by seeing enlarged muscles or fat behind the eyes on the CT scan (a special x-ray), and sometimes by a special blood test for chemicals (antibodies) attacking the thyroid.
When Graves disease affects the eyes, several problems can occur:
- The inflammation can result in redness of the eyes and pain and pressure around the eyes. If it is mild, this can be treated with medications like Advil (ibuprofen). In more severe cases, prednisone pills are used.
- The eyelids can open too widely, and this interferes with the way the eyelids blink and lubricate the eyes, resulting in dryness and irritation of the surface of the eys and discomfort. This is treated initially by using lubricating eye drops. After the diesase has stabilized, the eyelids can be placed back into their normal position by surgery.
- When the muscles are swollen they cannot move the eyes smoothly, and if the two eyes do not move together, then double vision can result. This can be treated by special prism glasses or surgery.
- If the swelling behind the eyes is severe, the eyes can be pushed forward in the socket (orbit). The pressure behind the eyes can damage the optic nerve, which carries the image from the eye to the brain, decreasing the vision. The first treatment is with prednisone pills., Some patiens require orbital decompression surgery, which opens the bones arouund the orbit to allow more room for the swollen muscles, relieves the pressure on the optic nerve, and allows the eye to move back into the orbit.
The eye symptoms of Graves disease can be quite distressing and can last for some time. Once the disease has stopped evolving, corrective surgery can generally improve the comfort, eliminate the double vision, and even improve the appearance of the eyes.