Thyroid eye disease or thyroid-related orbitopathy is a debilitating auto-immune condition. In about 50% of patients who have Graves disease (over active thyroid) suffer from eye-related disease. Less than 10% of these patients can even lose vision from compression of the optic nerve by enlarged extraocular (eye) muscles. Quality of life is significantly reduced in patients with even the mild form of this disease. There are a multitude of symptoms such as bulging or protruding eyes (exophthalmos or proptosis),
impaired lid closure (lagophthalmos), double vision, and eyelid retraction (eyelid pulled up and or down).
Eyelid retraction leads to a compromised corneal surface which induces blurred vision, photophobia, foreign body sensation, and even corneal ulceration. In addition, eyelid retraction often presents an unacceptable level of cosmetic deformity and discomfort from the tightness of the eyelids. Bulging or proptosis causes pressure discomfort behind the eyes and if severe enough, vision threatening compression of the optic nerve.
Patient with bulging (proptosis) of eyes and upper and lower eyelid retraction.
Treatment of thyroid eye disease is multidisciplinary. Coordinated care with your primary care physician, endocrinologist and ophthalmologist are essential in the management of this disease. In this manner,
Dr. Korn is a member of a multidisciplinary team of ophthalmologists at the UCSD
Shiley Eye Center that manages patients with
thyroid eye disease.
The time course of eye symptoms from thyroid-related orbitopathy follow's Rundle's curve. In general, there is an initial deterioration of the symptoms followed by a period of stability and then improvement. From start to finish, this time course is approximately 1 year. Because of this variation, we wait for the eye disease to stablize before definitive intervention.
Rundle's Curve for Thyroid Eye Symptoms
A common misconception is that the thyroid gland causes eye and orbital symptoms. This is however, not the case. Thyroid-related orbitopathy is an auto-immune disease and it is the immune system that causes the eye findings and thyroid enlargement. This process may occur simultaneously or independently.
Once your eye symptoms have stabilized, treatment proceeds in a three-fold manner.
Stage 1: Orbital decompression
Stage 2: Strabismus surgery
Stage 3: Eyelid retraction repair
In stage 1, the eyes are moved back into the eye socket by a combination of techniques in which bone around the eye socket (orbit) are delicately reduced as well as removing fat behind the eye. Once orbital decompression has been completed, if double vision is present, then strabismus surgery is performed to align the eyes (stage 2). Finally, eyelid retraction is performed as the final step bringing the retracted eyelids back into their proper position.