Thyroid Eye Disease

Abstract

Thyroid eye disease (TED) is an autoimmune condition usually associated with thyroid dysfunction and characterised by inflammatory and fibrotic changes in the periocular tissues. It is most commonly associated with hyperthyroidism, but patients with TED may also be hypothyroid or euthyroid, and it does not always present at the same time as the thyroid dysfunction. Patients may present with inflamed eyes, ocular surface discomfort, double vision, and proptosis and may even progress to optic nerve compression and visual loss.

Risk factors include smoking and radioiodine treatment. Early recognition is important since treatment in the active phase with steroids, immunomodulatory agents, and sometimes radiotherapy can prevent persistent disability and disfigurement. Once the disease is inactive, treatment is focused more on surgical rehabilitation, with orbital decompression, strabismus surgery, and lid surgery. Urgent orbital decompression may be needed if the optic nerve is compressed. People with TED may have significant psychological distress related to hormonal changes, vision problems, changing appearance, and medication side effects, and the psychological care of these patients is often neglected. Future developments may offer the possibility of earlier diagnosis, biologic treatments tailored to the disease to stop its activity, and effective less invasive surgical rehabilitation.

It is imperative that clinical practitioners are familiar with the clinical features of Graves’ ophthalmopathy. Furthermore, the thyroid endocrine nurse must be equipped with the relevant knowledge and understanding of eye anatomy and how thyroid eye disease (TED) presents. In this way, any eye signs and symptoms can be identified early, and managed more effectively, potentially reversing GO if referred promptly to an ‘endocrine’ ophthalmologist who specialises in thyroid eye disease.