Ocular thyroid disease, also known as Graves’ ophthalmopathy, is an autoimmune disease. In this condition, the body’s immune system attacks the tissues around the eye, causing inflammation in the tissues around and behind the eye. The disease also affects the thyroid gland, causing Graves’ disease. Graves’ disease most often causes hyperthyroidism and, in rare cases, hypothyroidism.
Ocular thyroid disease can occur in people with hyperthyroidism, hypothyroidism, or even in people with normal thyroid function. It has also been seen in cases where people have developed the disease after treatment for Graves’ disease. For this reason, it is recommended that people with ocular thyroid disease be under the constant supervision of an ophthalmologist and an endocrinologist.
Who is more likely to develop ocular thyroid disease?
In general, thyroid eye disease has been reported in a quarter of people with Graves' disease, either before, after, or during the course of the thyroid disorder. If a person has no symptoms of thyroid eye disease at the time of Graves' disease, is not a smoker, or has quit smoking, their chance of developing this eye condition is one in ten. If the person is a smoker, the chance doubles. People who smoke more than others are eight times more likely to develop thyroid eye disease than nonsmokers. Other risk factors include:
Age: It usually affects middle-aged people, but it can occur at any age.
Gender: The rate is higher in women than in men.
A family history of thyroid eye disease
Radioactive iodine: Radioactive iodine has been used to treat hyperthyroidism and Graves' disease. This treatment should be used with caution in people with active thyroid eye disease because it may worsen the condition unless the patient is also taking steroid medications.
Low selenium levels: A deficiency of selenium (a mineral) in the blood
What are the symptoms of thyroid eye disease?
If you experience any of the following symptoms, you should see your doctor to check for the possibility of developing this condition:
Changes in the appearance of your eyes (usually squinting or bulging eyes)
Excessive dryness in your eyes
Feeling of wetness in your eyes
Uncomfortable exposure to bright lights
Swelling in your upper and lower eyelids
Redness in your eyes and eyelids
Puffiness under your eyes
Blurred vision or double vision
Pain behind your eyes (especially when you look up, down, or to the side)
Difficulty moving your eyes
If you have swollen eyelids or puffiness around your eyes and you also have hypothyroidism, you probably don't have this eye condition. These symptoms will go away after taking levothyroxine.
Sometimes it can be difficult to diagnose this condition, and you may be mistaken for hayfever, conjunctivitis, or allergies. Seasonal.
In this condition, it is very difficult to diagnose ocular thyroiditis and the person should be monitored more carefully. The following conditions are more common when a person has ocular thyroiditis:
Hay fever usually occurs in a specific season and its symptoms are likely to be seen only during the outbreak season.
Seasonal allergies usually cause itchy eyes, while this does not happen in ocular thyroiditis.
Conjunctivitis causes a sticky feeling in the eyes, while this is not seen in ocular thyroiditis.
In ocular thyroiditis, when a person tries to look up or to the sides, he will feel pain in the back of his eye. In hay fever, allergies and conjunctivitis, the person will not experience this type of pain.
Unlike the other diseases mentioned, in ocular thyroiditis, the person will struggle with double vision.
Treatment of ocular thyroiditis
In stages In the early stages of thyroid eye disease, where the person feels excessively dry in the eyes or feels uncomfortable when staring at a bright lamp, artificial tear drops are very helpful. Oily gels and lubricants are also very effective in this case. Oily lubricants last longer but can cause blurred vision in some cases, so it is best to use them only in severe cases and at night.
While the symptoms of the disease can be severe in the first 6 to 12 months of the disease, after this period the condition of the eyes will largely return to their original state. However, if the eye is severely inflamed, steroid treatments will be prescribed for the person, steroid drugs are administered orally or intravenously.
Steroids will greatly reduce double vision by reducing inflammation of the eye muscles and making their movement easier. In addition, these drugs play a very important role in reducing redness of the eyes and swelling of the eyelids. In severe cases Thyroid eye disease, steroids will help to return vision to normal to a large extent.
If the severity of thyroid eye disease is high, combined treatments will be used to treat thyroid eye disease more effectively. In this case, the patient will receive immunosuppressive drugs and radiotherapy in addition to steroids. However, steroids are not effective in treating bulging eyes.
Unfortunately, some people with this disease suffer from permanent double vision or changes in the appearance of the eyes.
When the eye inflammation is largely controlled, these people are prescribed rehabilitative surgery.
Decompression surgery: In this surgery, more space is created in the back of the eye to reduce pressure on the eye neurons. Or if the eyes are more protruding than normal, this surgery will greatly help the eyes close better.
Eye muscle surgery: If double vision is not treated by attaching a prism to prescription glasses, this surgery will help treat this condition.
Eyelid surgery: This surgery will be performed to protect the eyes.
What should be done if the symptoms of ocular thyroid disease worsen?
In only 5% of people with ocular thyroid disease, ocular thyroid disease worsens. In this disease, the eyelids do not close properly, and at the same time, there is a vulnerable window in front of the eye called the cornea, which may become scarred and subsequently damage the person's vision.
In rare cases, even the optic nerve that carries messages from the eye to the brain is damaged, and in these cases the person will lose their vision completely. The sooner these problems are diagnosed, the more successful the treatment will be.
Symptoms that should be seen immediately by a doctor
If you see these symptoms, you should see a doctor immediately:
Symptoms of the disease worsen over several days or weeks.
Blurred vision does not go away with blinking or covering the eyes periodically.
The person is unable to distinguish colors as clearly and clearly as before.
Double vision when looking forward
The person has to tilt their head back to the sides to prevent double vision.
Thyroid problems often occur in people with a family history. Therefore, if someone in the family has these diseases, the person should also be under the constant supervision of a doctor to get the necessary medical tests. Of course, only a specialist doctor can provide the person with the necessary guidance and solutions.
Preventive measures to prevent the disease from worsening
Quitting smoking: A person can receive a smoking cessation program by visiting a doctor. The chances of treating smokers with thyroid eye disease are lower than other people, if the person quits smoking, they will respond to treatment.
Preventing high and low thyroid hormone levels: Preventing fluctuations in thyroid hormones is especially important in hypothyroidism. Therefore, the affected person should have regular blood tests and follow the doctor's recommendations regarding the amount of medication taken. Thyroid hormone levels should always be normal so that this eye condition does not occur.
Avoid radioactive iodine treatment: Radioactive iodine treatment will worsen thyroid eye disease. This problem is more common in smokers. In this case, the person should consult their doctor.
Taking selenium supplements: New research shows that people with thyroid eye disease will see acceptable results if they take selenium supplements for 6 courses (twice a day). This medicine can be obtained from pharmacies without a prescription.
Does thyroid eye disease affect the quality of life?
This disease will affect the affected person psychologically and will greatly affect their social life. If the level of thyroid hormones rises and falls, the mood of the person will constantly change, the person will be irritable and nervous, and this condition will continue until these hormones are at a stable level.
The person will experience anger, loss of self-confidence and social withdrawal due to the change in the appearance of their eyes. The affected person's work and emotional relationships will also be greatly affected by this disease, because the face and eyes play a very important role in communicating between people. Treatments such as surgery will be helpful in many cases. The affected person should be under the close supervision of a specialist physician.