Management of Thyroid Eye Disease
Treatment of the active phase
It is important for the thyroxine level to be corrected and this is best managed by an endocrinologist (a physician who specialises in treating hormone disorders). The endocrinologist and ophthalmologist will work closely together to manage the thyroid gland disorder and the TED.
Initial treatment of the active phase of TED can include:
- Stopping smoking – smoking has been strongly linked to progression of TED so it is important to stop smoking to try to minimise the risk of progressive and permanent eye problems
- Lubricants and cool compresses – can help alleviate eye discomfort and swelling
- Selenium supplements – can help reduce the severity of mild active TED
- Intravenous or oral steroids – can help reduce the activity of TED
- Orbital radiotherapy – can help reduce progression of double vision in TED
- Hyaluronic Acid filler injections (e.g. RestylaneTM) can be used to temporarily reduce upper & lower eyelid retraction and thus improve closure and comfort of the eyes
- Botulinum toxin (e.g. BotoxTM, AzzalureTM) injections can be used to temporarily lower a retracted upper eyelid
- Glaucoma treatment- the swollen orbital tissues may result in an unacceptably high pressure in the eyes (intraocular pressure) Glaucoma medication in the form of eyedrops may be needed to lower the intraocular pressure
- Orbital surgery – rarely orbital decompression surgery is required to reduce pressure on the optic nerve or to reduce severe sight-threatening exposure of the eye
The eye and visual function should be carefully monitored by an ophthalmologist throughout the active phase of TED.
A CT or MRI scan of the orbits may be required to help confirm the diagnosis of TED and exclude other possible causes of a protruding eye (proptosis).
TTreatment of the inactive phase of TED
- Orbital decompression surgery
- Squint (strabismus) surgery for double-vision
- Eyelid retraction surgery
Orbital Decompression Surgery
Orbital decompression surgery involves removal of 1, 2 or 3 of the 4 walls of the bony orbit and/or orbital fat to create more space for the eyeball and other orbital tissues.
Orbital decompression surgery can:
- Reduce the prominence of the eyeball
- Reduce the degree of exposure of the eye
- Reduce pressure on the optic nerve (and so help preserve vision)
- Reduce congestion of the orbit and subsequent swelling of the soft tissues around the eye
- Reduce deep orbital pain associated with TED
Click here for more information on orbital decompression surgery
Squint (strabismus) surgery
Thyroid eye disease can sometimes result in troublesome double vision. Orbital decompression surgery can cause or worsen double vision. If double vision persists it may require assessment and treatment by a squint specialist (an ophthalmologist who has specialised in the management of squint).
Some patients can be helped with botulinum toxin injections and others require surgery to improve the misalignment of their eyes.
Eyelid retraction surgery
TED can result in upper and lower eyelid retraction. Eyelid retraction can emphasise a starey eyed appearance and can result in incomplete eyelid closure (lagophthalmos) and dry eye problems.
Eyelid retraction can sometime improve after orbital decompression surgery. Squint surgery can sometimes improve upper eyelid retraction but can sometimes worsen lower eyelid retraction.
For the above reasons surgery to improve eyelid retraction should be performed after orbital decompression or squint surgery if these procedures are also required.
Click here for more information on eyelid retraction surgery.
TED can result in marked changes to the eyelids and facial appearance. Enlargement of the orbital fat can result in the appearance of puffy lower eyelid bags. The swelling of the eyelids in the active phase and subsequent resolution can leave behind redundant skin in the upper and lower eyelids. Blepharoplasty can help address both of these problems to help restore a patient’s pre-TED appearance.
Click here for more information on blepharoplasty surgery