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Options for Treating Thyroid Eye Disease

By Jennifer I. Hui, MD
Dry eyes may be a concerning symptom of those with thyroid dysfunction.

The popular TED conferences feature inspiring talks about technology, entertainment or design. This “TED Talk,” however, is focused on thyroid eye disease (TED) and expands upon my January/February article about how the small thyroid gland affects the entire body, including our precious eyes. 

If someone with thyroid dysfunction is experiencing symptoms of eyelid swelling, eye pressure, pain, dryness or changes in vision, their endocrinologist may refer them to an ophthalmologist (usually an orbital/oculoplastic surgeon) for treatment of thyroid eye disease (TED). These specialists work closely with endocrinologists to manage patients with TED. 

In milder cases, patients may experience dry eyes as the most concerning symptom.  This is typically managed with over-the-counter artificial tears to lubricate the eyes; an eye ointment may also be advised.  If symptoms progress, more frequent follow-up care is needed, including monitoring lab values of TSH and other related factors.

Some patients are advised to have oral steroid treatment to calm the inflammation around their eyes; others are referred for radioactive iodine treatment.  The radioactive iodine is preferentially absorbed by the thyroid gland and the goal is to have the radioactive material chemically suppress the gland.  If a person’s symptoms worsen or their lab values indicate, surgical removal of the thyroid is recommended (thyroidectomy) to control the eye symptoms. 

In severe cases of TED, ocular surgery may be required to preserve sight.  When the tissues around the eyes swell so much that the eye is protruding from the lids and there is nerve damage causing vision loss, an orbital decompression is recommended.  This involves surgical removal of the bones around the eye which allows for the eye to “sink” back into the socket and restore a more normal position.  This improved position will allow for more normal eyelid function and closure over the eyes.  

In cases where a person has double vision from misalignment (called strabismus), surgery may necessary to restore the position of the eyes.  If someone is affected by dry eyes from retracted eyelids, botulinum toxin (Botox) may be administered to the upper eyelid to overcome the muscles that are too tight.  The toxin may relax the muscles and thus allow the eyelid to lower its position and close more easily over the eye.  If the retraction is severe, eyelid surgery to correct the position may be needed.  

If you have a thyroid condition, it is important to pay close attention to changes with your eyes. While serious eye conditions can occur with thyroid disease, if managed early, symptoms are often improved with minor therapies and more invasive interventions may be avoided. A close working relationship between the patient, endocrinologist and ophthalmologist is key to ensuring the best care possible. 

Dr. Hui is the founder of The Eyelid Institute in Palm Desert. She is a board certified ophthalmologist and oculoplastic surgeon with a special interest in helping patients with eyelid, lacrimal and orbital conditions. She can be reached at (760) 610.2677.

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