In patients with thyroid disease, especially graves thyroid, some problems such as enlargement of the eyes, googly eyes, and retraction of the upper eyelid may occur. We call this graves ophthalmopathy, or in other words, thyroid-related eye disease.
Why Does Thyroid Cause Eye Disease?
Thyroid-related eye disease is an autoimmune disease. We can briefly define autoimmune diseases as follows. Our body perceives some of its own substances as foreign substances and develops a defense and reaction against these substances. In this process, the body’s defense mechanisms come into play and it takes a defensive position against that substance and even goes into attack mode. This causes inflammation. There is swelling, redness, edema, and pain where there is inflammation. This is a kind of war zone. Although the etiology of thyroid-related eye disease is not fully known, it activates the defense cells around the eye against some substances originating from the thyroid and initiates an immune reaction.
What Kind of Complaints Does Thyroid-Related Eye Disease Cause in the Eye?
- Eye growth
- Googly eye appearance
- Redness in the whites of the eyes
- Edema in the whites of the eyes
- Retraction of the upper eyelid
- Dilution
- Pain
- A feeling of pressure in the eye
- Limitation of movement
- Eyelid swelling
- Herniation of fat pads in the eyelid
- It causes many complaints such as double vision.
Active Thyroid Orbitopathy Stage:
In this phase, which we call the active phase, inflammation is intense. It causes serious symptoms such as pain, redness, swelling, and protrusion of the white layer inside the eye, which we call chemosis, limitation of movement and double vision, wounds on the pupil due to excessive enlargement of the eye, moderate and even severe vision loss as a result of swelling of the tissues in the orbit and pressure on the optic nerve.
Chronic Thyroid Orbitopathy Stage:
In this phase, which we call the chronic phase, the findings in the active phase regress. They mostly have complaints such as enlargement of the eye, double vision, eyelid traction, vision loss due to pressure on the optic nerve, and wounds in the pupil due to enlargement of the eye.
Can it be treated? What kind of treatment is there?
We can divide the treatment of this disease into three.
- Medication
- Radiation therapy
- Surgical treatment
When and How is Drug Treatment Done?
In the active phase, our choice is usually medication. However, if vision loss occurs due to pressure on the optic nerve, urgent decompression, that is, surgery, may be needed. In drug treatment, we generally prefer oral or serum cortisone, immunosuppressive drugs, and vitamins. Inflammation is usually controlled with medication. But sometimes drug treatment may be insufficient. In this case, it is necessary to give radiation therapy.
In Which Patient or Stage Is Radiation Therapy Used?
We recommend radiation therapy for patients who do not benefit from drug therapy. Low-dose radiation therapy, which does not harm eye tissues, is applied and inflammation is mostly controlled
When and to whom is surgical treatment applied?
Surgical treatment is generally a treatment for problems that cannot be resolved with medication after the active phase has passed. We can list these treatments as follows;
- Removing the enlarged eye with decompression surgery
- Strabismus surgeries to eliminate double vision
- They can be listed as surgeries performed on the eyelid.
Do Eye Problems Recur?
Despite all these treatments, unfortunately, new attacks may sometimes occur. Therefore, it is necessary to check patients at regular intervals.