Thyroid-Related Eye Disease (Thyroid Ophthalmopathy)

Thyroid Ophthalmopathy is an inflammatory disease affecting ocular and extraocular orbital tissues, mostly associated with autoimmune thyroid disease.

Our eye is located in a conical bone cage called the orbit. The muscles, fat and connective tissues around the eye hold the eye in its proper place within this bony structure. However, due to thyroid disease, edema (swelling) develops in these muscles, fat and connective tissues.

As a result, protrusion of the eyes (exophthalmos), excessive opening of the eyelids (retraction), double vision (strabismus) due to restriction in the muscles (restrictive myopathy), redness, burning, stinging and even melting-puncture of the cornea due to exposure of the corneal tissue (lagophthalmos and corneal exposure), and blindness as a result of optic nerve compression (compressive optic neuropathy) may develop.

Graves’ disease (90%) is the leading cause of thyroid ophthalmopathy. Less frequently, Hashimoto’s thyroiditis, thyroid cancer and primary hyper- or hypothyroidism of unknown cause may be observed.

Graves’ disease often affects women between the ages of 40 and 50. The diagnosis of Graves’ disease may have already been made, or the first findings can be ocular findings and the disease can be diagnosed in the light of these findings.

When patients are diagnosed, they may be hyperthyroid, hypothyroid or euthyroid in terms of blood values. In a small group of patients (10-25%), only ocular findings may be observed without thyroid disease symptoms (Orbital Graves).

Graves’ ophthalmopathy typically has a 2-phase clinical course. In the active phase, which is the first phase of the disease, the disease follows a more inflammatory process, while fibrosis is more effective in the so-called inactive phase.

The stage of the disease is very important for the treatment plan. While drug treatments (cortisone) are more prominent in the active phase, surgical treatments can be planned according to the severity of the disease in the inactive phase. However, there is no definite order for any of these treatments.

However, abnormal thyroid blood values and smoking are two very clear undesirable conditions in this disease. It is very important for smokers to quit smoking immediately and to bring thyroid blood values to normal levels with medication or surgery in terms of the course of the disease.

The follow-up and treatment of thyroid ophthalmopathy should be planned individually by an experienced oculoplastic surgeon, taking into account the symptoms and findings of the patient. First of all, it should be decided whether the patient is in active or inactive period and the treatment plan should be organized accordingly.

In patients in the active phase, simple drug treatments (artificial tears, selenium supplementation, etc.) may be sufficient if mild symptoms are observed, while intravenous cortisone treatment and even emergency orbital decompression should be considered in patients with more serious symptoms. In patients who are considered to be in the inactive stage, treatment mostly includes sequelae (residual disorders) surgeries.

These treatments generally include orbital decompression surgery to restore the protruding eyes, strabismus surgery to treat double vision (strabismus) if it has developed or if it develops after orbital decompression surgery, and finally eyelid surgeries to treat eyelid level changes (especially eyelid retraction). However, these treatments should be planned by an experienced oculoplastic surgeon, completely tailored to the patient.