Thyroid Eye Disease

Thyroid associated ophthalmopathy (TAO) – also known as Graves’ orbitopathy or thyroid eye disease – is an autoimmune condition that can lead to changes in the appearance of the eye and eyelids, ocular discomfort, double vision, dry eyes and tearing, corneal exposure, and even blindness in some cases. This condition usually occurs in people with hyperthyroidism (overactive thyroid) or a history of hyperthyroidism due to Graves’ disease, but may also occur in patients with hypothyroidism or no known thyroid abnormalities.

Symptoms include:

• Bulging eyes
• Decreased eye movement
• Double vision
• Excessive tearing or dry eyes
• Eyelid retraction (abnormal elevation of the upper eyelids and lowering of the lower eyelids, which can give the eyes a sad, “hollow” appearance)
• Feeling of irritation or grittiness in the eyes
• Loss of vision
• Pain or pressure
• Redness or inflammation of the conjunctiva (white part of the eyeball)
• Photophobia (sensitivity to light)
• Swelling of the eyelids

Our oculoplastic surgeons evaluate patients with TAO, and have a variety of medical and surgical treatments to address both functional (loss of vision, double vision, extreme eye dryness) and cosmetic aspects of this disease.

In addition, our surgeons are conducting ongoing research of TAO aimed at improving treatment for patients.

Tests

Comprehensive Exam – Your doctor will conduct a thorough exam of your eyes, checking specifically for swelling and enlargement of the eye muscles.

Imaging – Your ophthalmologist may order a computerized tomography (CT) scan or MRI (magnetic resonance imaging) to get a detailed image of your eye.

Treatments

General Health Management – Avoid smoking or being in environments around smoke. Studies have shown that smokers have up to an eight times increased risk of developing severe TAO.

Managing Hyperthyroidism – You should work to keep your thyroid blood levels in the normal range to help decrease the risk of developing thyroid eye disease. If you have evidence of active TAO, it is very important that you have close follow up with both your ophthalmologist and endocrinologist.

Selenium – Taking the supplement selenium (100 ug twice daily as sodium selenite) may improve quality of life, decrease ocular problems, and reduce progression of mild TAO. You should speak to your doctor about whether you should begin selenium supplementation if you have TAO.

Eye Drops or Ointment – Use lubricating eye drops – such as artificial tears – to help relieve dryness and scratchiness, especially before you go to bed. Ointment may be beneficial at night to help with dryness, particularly in areas with air conditioning or a fan.

Eye Shield – In some cases where the eyes do not close completely when you are sleeping, we also recommend you use an eye shield in addition to the ointment while sleeping.

Sleeping Modification – In cases where there is significant inflammation, we often recommend you sleep with your head elevated.

Orbital Decompression Surgery – Your ophthalmologist may recommend that you undergo surgery in which the bone between your eye socket (orbit) and sinuses is removed to allow more space for the swollen tissues.

Wear Sunglasses – Protect your eyes from the sun and wind by wearing sunglasses when you are outside.