Thyroid eye: Treatment, symptoms, advice and help

About thyroid eye

Thyroid eye or Graves' ophthalmopathy occurs in some patients with Grave’s disease. It refers to proptosis of the eye, caused by infiltration of the retrobulbar tissues with fluid and round cells, with a varying degree of retraction or spasm of the upper eyelid.

Thyroid eye: Incidence, age and sex

Grave’s disease is the most common cause of hyperthyroidism in children and adolescents and usually presents itself during early adolescence. It has a powerful hereditary component and affects up to 2% of the female population. It has a female:male incidence of 5:1 to 10:1. About 20-25% of people with Graves' disease will also suffer from Graves' ophthalmopathy.

Signs & symptoms of thyroid eye: Diagnosis

There is protrusion of the eyes, redness and swelling of the eyelids. Widening of the palpebral fissure occurs so that the sclera may be seen clearly above the upper margin of the iris and cornea.

Causes and prevention of thyroid eye

Graves' disease is an autoimmune disease where the thyroid is overactive, producing an excessive amount of thyroid hormones. This is caused by autoantibodies to the TSH-receptor. Thyroid eye is caused by the inflammation of the eye muscles by attacking autoantibodies. Lid spasm occurs because the levator palpebrae superioris muscle is partly innervated by sympathetic fibres.

Thyroid eye: Complications

Weakness of the extraocular muscles, particularly the elevators results in diplopia. In severe cases papilloedema and corneal ulcerations occur.

When severe and progressive, it is known as malignant exophthalmos and the eye may be destroyed.

Thyroid eye: Treatment

Spasm and retraction usually disappear when the hyperthyroidism is controlled. They may be improved by beta-adrenergic blocking drugs, for example guanethidine eye drops. Exopthalmos tends to improve with time. Sleeping propped up and lateral tarsorrhaphy will help to protect the eye but will not prevent progression. Hypothyroidism increases proptosis by a few millimeters and should be avoided.