Thyroid Eye Disease
Bulging eye from thyroid eye disease is one of the most common conditions Dr. Eftekhari treats. Many patients in the general population have thyroid disease, and a common condition is high thyroid or Graves’ disease. In Graves’ disease, patients may experience weight loss, palpitations, tremors, and other symptoms. Almost one-half of patients with Graves’ disease will also develop changes around their eyes - bulging eyes, puffiness, swelling, and overall change in appearance. The reason for this change is because some patients develop abnormal antibodies that cause growth of the eye fat and muscular tissue in the eye socket. In some cases this can cause scarring and permanent vision loss or double vision.
Symptoms of Thyroid Eye Disease
At first it can be hard to tell that symptoms are related to your thyroid. Many patients say their eyes have more tearing, redness, irritation or puffiness around their eyes. Sometimes patients notice that one eye is bulging. If you have these symptoms, consider calling our office for a consultation.
More severe cases of thyroid eye disease can cause significant bulging of one or both eyes (proptosis). This can be accompanied with an abnormal appearance of the eyelid called eyelid retraction. This can occur in the upper eyelid -- which almost looks like the windowshade of the eye has been pulled too high. Or it can happen in the lower eyelid, where the white of the eye shows below the eye. Rarely, patients can get double vision because of a scarred eye muscle.
Typical Course of Thyroid Eye Disease
In many patients, the signs and symptoms of thyroid eye disease will increase and peak over the course of a few months, and then partially subside. This process can take 18 to 24 months to run its course, although there is significant variability. In almost all patients, their eyes may get a little bit better but do not return to their previous state or appearance.
Treatment for Bulging Eyes
For patients who have significant signs of thyroid eye disease, Dr. Eftekhari may recommend treatment. Traditionally this consisted of weekly steroid infusions or oral steroids, both of which have many side effects. For some patients, there is a new infusion medication that was just approved by the FDA for thyroid eye disease. Tepezza (teprotumumab) is the first medication approved specifically for this condition. Dr. Eftekhari may recommend this medication depending on the severity of the disease.
For patients who do not respond to medical therapy or who have chronic thyroid eye disease with scarring, Dr. Eftekhari may recommend surgery. Some surgery is directed at creating more space in the eye socket for the bulging eye to sit farther back into the eye socket (orbital decompression) and other surgery is directed at addressing abnormalities of the eyelids (eyelid retraction surgery). Dr. Eftekhari has extensive experience performing these surgeries. Dr. Eftekhari is board-certified and is a member of the International Thyroid Eye Disease Society (ITEDS) and the American Society for Ophthalmic Plastic and Reconstructive Surgery (ASOPRS).
If you have thyroid disease and have noticed changes around your eyes, call our office for a consultation.