Thyroid Eye Disease (TED), also known as Graves’ Orbitopathy, is a disorder of the immune system that involves the tissues of the eye becoming inflamed and swollen. This can cause the eyes to push forward, giving them a stare appearance. The immune system may independently attack the healthy cells of the Thyroid and the eye at the same time, but TED and Thyroid disease or Graves’ disease are not the same process. Even if your Graves disease is under control, you may still have eye problems for years afterwards.
Once TED becomes active, it can last anywhere from 1 to 3 years, and it is during this time that the eye symptoms first begin to appear. In some patients, symptoms can persist for many years even after the thyroid disease is under control. After the disease becomes inactive, symptoms can still be present, but the disease can sometimes be harder to treat. This is because scar tissue may begin to form, causing any physical or vision changes to become permanent, possibly requiring surgery to fix.
Symptoms
- Dryness
- Redness
- Irritation
- Swelling or bulging of the eyes
- Light sensitivity
- Pressure headaches
- Vision changes
- In rare cases (3-5% of the time), pressure on the optic nerve caused by TED can cause permanent vision loss if left untreated.
Signs
Due to the nature of Thyroid Eye Disease, the sooner signs and symptoms are recognized, the better.
- Do your eyes look different – bulging eye or pulled back eyelid?
- Do your eyes change during the day?
- Do your eyes feel more sensitive – dry, watery or painful?
- Are your eyes red or swollen?
- Have you noticed changes to your sight – blurry vision, double vision or light sensitivity?
If you answered YES to any of these questions, you should talk to your doctor about the symptoms you have noticed.
Diagnosis
As an Oculoplastic Surgeon, Dr. Eftekhari can conduct initial orbital exams and monitor any changes that occur over time, as well as creating a treatment plan with you for your individual case of TED. If you also have Graves’ disease, Dr. Eftekhari will work with your endocrinologist to help manage your diagnosis. Dr. Eftekhari works closely with the thyroid surgeons at Ear Nose and Throat Center of Utah – Dr. Pramod Sharma and Dr. Jason Diaz – and treats many patients just before or after thyroid removal surgery.
Treatment Options
There are a variety of treatment options that Dr. Eftekhari will discuss with you. We want to make sure that whatever you choose to do, you will receive the best care possible for your current situation.
For many patients, using topical lubricants and artificial tears (Refresh, Tears Naturale, Genteal gel), or taking supplements, like Selenium selenite, can alleviate the discomfort caused by TED. Selenium selenite (100 mcg taken by mouth twice a day) can be found at your local GNC or other supplement store. Other home remedy options include tinted glasses, sleeping with eye shields, and sleeping propped up to alleviate pressure.
During the active stage of Thyroid Eye Disease, it is more important to tackle the source of the problem so that the discomfort does not become permanent. Dr. Eftekhari may recommend you take certain medications or he may decide that surgery is necessary, and this will depend on the progression of your Thyroid Eye Disease. As of January 2020, a new medication for thyroid eye disease became FDA approved called teprotumumab. Dr. Eftekhari may discuss this medication depending on your disease severity.
Orbital Decompression is an operation in which we make more room behind the eye. This allows the eye to move back into the eye socket, improving eyelid closure and treating dryness; and helps to relieve the pressure on the optic nerve, preventing damage. The operation involves removing fat and bone from behind the eye. This surgery may improve your condition in many ways, including cosmetic appearance.
Complications
As with any procedure, minor bruising or swelling is expected, and will most likely disappear after 2-4 weeks. Other potential risks include: bleeding, infection, scarring, double vision, eyelid swelling that may persist for months, and possible vision loss.
Dr. Eftekhari always endeavors to improve the conditions of his patients, while making all of his procedures as low-risk as possible. However it is impossible to control all of the variables that may impact your final result. There is a chance that you may require additional treatment afterwards, and Dr. Eftekhari can assist you with any follow up questions you may have.
Further questions? Check out these websites: thyroideyedisease.org and asoprs.org