Thyroid Eye Disease


What are the treatments?
All patients with significant TED should be under the care of an ophthalmologist who is able to monitor them regularly. Ideally, the ophthalmologist should be able to work closely with the the patient’s GP/ endocrinologist.

The principles behind the treatment of TED involve:
Ensuring that the patient is euthyroid and stopping/ refraining from smoking
It is vital that all patients ensure that they do not smoke and that their thyroid hormones are as well controlled as possible.

Reducing exposure symptoms
For the vase majority of TED sufferers who suffer from mild symptoms of overexposure of the eyes only, the use of eye drops, wrap-around tinted glasses, sleeping with eye shield with the head elevated can have a dramatic effect.
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Reducing the effects of inflammation in patients in their active phase
When there is active inflammation with more severe symptoms, oral steroids or other anti-inflammatory medications may be needed to reduce the swelling. Radiation treatment is sometimes used to treat active inflammation as well.

 Treating sight threatening emergencies
In patients with sight threatening complications emergency surgery may be necessary to preserve vision. For example, severe overexposure of the cornea may lead to ulcer formation unless treated by orbital decompression surgery (removing part of the bony orbit and/or fat behind the eye) to restore the position of the eyeball back into the socket or by improving the closure of the lids with lid surgery. Unless sight threatening emergencies develop, most surgeons aim to perform rehabilitative surgery during the burnt out phase of the disease.

 Cosmetic and functional rehabilitation
The function and appearance of the eyes can usually be improved by surgery. Each type of operation will carry with it its own set of risks and benefits; thus patients can opt different types of surgery depending on the severity of their eye problems, their expectations for improvement and his/her attitude to the risk.
For example. many patients do opt for orbital decompression since it often has dramatic results improving coverage of the eyes themselves, allowing their eyes to return back to their normal position within the socket thus reducing the bulging/ staring appearance of the eyes. However some patients decline decompression surgery because of the small risk of blindness.
Misalignment of the eyes and double vision can be improved with eye muscle surgery (squint surgery) or optical prisms.
Eyelid surgery (lid elevation or lowering) to adjust the position of retracted lids can improve eyelid closure and restore eyelid function.
Removal of excessive fat and skin (blepharoplasty) from the eyelids can also improve their appearance.
Is the surgery effective?
While it may not be possible to completely eliminate all of the consequences of thyroid eye disease, surgery to correct these conditions is generally successful in satisfactorily restoring function, comfort, and cosmetic appearance.

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Preoperative (above) and postoperative (below) pictures of a patient who underwent eyelid rehabilitation for thyroid eye disease.
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This lady with burnt out thyroid eye disease complained of a staring appearing to her eye and bulging eyelid bags. She had quite marked bulging of the fat around all 4 eyelids and retraction of her left upper lid- all due to the thyroid eye disease. She underwent blepharoplasty of all four lids combined with lowering of the retracted left upper lid.








Further Reading:
http://www.optometry.co.uk/articles/docs/856fa5e9bc28c3783e8352491f0089af_gurwood20001103.pdf
http://www.rcophth.ac.uk/docs/members/focus-collegenews/FocusSummer03.pdf