New York, NY — January 27, 2021
According to the National Organization for Rare Disorders, thyroid eye disease (TED) affects an estimated 1 in every 6,250 women and 1 in 34,482 men. Left undiagnosed and untreated, it is a condition that can contribute to vision loss. What is the cause of TED, and how is it managed? State University of New York (SUNY) College of Optometry clinician-educators Harriette Canellos, OD, and Patricia Modica, OD, provide answers to these questions and more about the disease.
Defining TED
Thyroid eye disease is caused by inflammation in the tissues surrounding the eyes. The condition is often found in people with Graves’ disease, an autoimmune disorder that can cause excess thyroid hormone production (hyperthyroidism). With Graves’ disease, the body mounts an attack against itself, and antibodies attack the thyroid — the butterfly-shaped endocrine gland located at the lower front of the neck — and sometimes the cells behind the eyes, which can lead to TED (also called Graves’ eye disease, Graves’ orbitopathy or thyroid-associated orbitopathy). According to the American Thyroid Association, up to one-half of people with Grave’s disease develop eye symptoms, including pain, swelling, and inflammation.
“When these eye structures become inflamed, the eyes become red, and the muscles swell up, making it hard for the eye to move,” says Dr. Canellos, associate clinical professor at SUNY Optometry and director of the University Eye Center (UEC) referral service. “Additionally, the eyelids tend to become stuck in an upward position, causing patients to have a stare-like appearance.”
“Double vision can occur due to swelling of the eye muscles. The eyes can bulge outward to the extent that the patient can no longer close them, causing damage to the cornea and permanent scarring,” adds Dr. Modica, clinical professor at SUNY Optometry and director of the Neuro-Ocular Disease Service the University Eye Center. “The ocular muscles can swell dramatically, causing them to compress the optic nerve which can also lead to visual impairment. Fortunately, the more severe presentations are less common and can be treated.”
Because the eyes are a frequent target of Graves’ disease and can be involved without thyroid involvement, optometrists and ophthalmologists are often the first professionals that patients will turn to for care, says Drs. Canellos and Modica.
Diagnosis and treatment
When evaluating TED, your eye care provider will look at the ocular surface for dryness and inflammation signs. “If the patient has double vision, this will also be assessed to determine the extent of the ocular misalignment. It is also important to evaluate the function of the optic nerve by assessing vision, visual fields, and color vision,” explains Dr. Canellos. “The appearance of the optic nerve should also be assessed for signs of swelling.”
Imaging techniques such as computed tomography (CT) scan or magnetic resonance imaging (MRI) scan of the orbits will show characteristic enlargement of the eye muscles and will rule out other disorders that can cause a similar appearance.
For many coping with TED, the condition often improves on its own. Treatment is primarily geared towards making the patient comfortable. One or more of the following may help soothe your eyes and improve your vision, including:
- Lubricating with eye drops. Since dryness is a big issue, lubricating drops and gels (either over the counter or prescription) can help increase comfort and protect the ocular surface, says Dr. Modica. “The condition can also be problematic during sleep if patients have difficulty closing their eyes. In this instance, taping the eyes shut or wearing a sleep mask can be very helpful to prevent drying.”
- Wearing sunglasses.
- Elevating your head during sleep to reduce swelling.
- Taking supplements such as selenium can potentially reduce inflammation.
- Using prismatic lenses to help align eyes and alleviate double vision. In other cases, the patient has to patch the eye.
For severe cases, options include medications that suppress the immune system, surgery, or radiation treatment. “Tepezza® is a new medication that helps reduce the inflammation and shown to be effective in reducing the inflammatory signs, including the swelling, bulging eyes, and double vision,” says Dr. Modica. “If vision becomes threatened, medications can help reduce the swelling and protect vision.” Surgical techniques to expand the orbit can also allow for more space to protect the optic nerve and enable the eye to return to its normal position.
Living with TED
Graves’ disease and associated eye conditions usually cannot be prevented but it can be managed with consistent care and monitoring. Drs. Canellos and Modica recommend patients avoid smoking as it poses a greater risk for the development of more severe disease that threatens vision. And, although the inflammatory process of thyroid eye disease tends to run its course in 18 to 24 months, the doctors warn that inflammation can result in scar tissue in the ocular muscles that requires surgery to realign the eyes and lower the eyelids.
“It is important to monitor these patients over a suitable time frame. Although Graves’ disease and Graves’ eye disease both stem from an immune system’s attack on healthy tissue, not all patients will have involvement of both the thyroid and ocular tissue. Furthermore, while treatment of a coexisting thyroid abnormality is important, it has little impact on the ocular features.”
Both doctors emphasize that patients must be monitored regularly to ensure prompt treatment of severe eye findings, and undergo evaluation by their primary physicians and/or endocrinologists to ensure proper treatment of any abnormal thyroid function.
For more information about TED and other vision issues or to schedule an appointment with a provider at the University Eye Center, visit sunyopt.edu or call 212-938-4001. Telehealth services are available for both children and adults.
Organization contact: Adrienne Stoller, communications@sunyopt.edu, 212-938-5600
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About SUNY Optometry
Founded in 1971 and located in New York City, the State University of New York College of Optometry is a leader in education, research, and patient care, offering the Doctor of Optometry degree as well as MS and PhD degrees in vision science. The College conducts a robust program of basic, translational and clinical research and has 65 affiliated clinical training sites as well as an on-site clinic, the University Eye Center. SUNY Optometry is regionally accredited by the Commission on Higher Education of the Middle States Association of Colleges and Secondary Schools; its four-year professional degree program and residency programs are accredited by the Accreditation Council on Optometric Education of the American Optometric Association. All classrooms, research facilities and the University Eye Center, which is one of the largest optometric outpatient facilities in the nation, are located on 42nd Street in midtown Manhattan. To learn more about SUNY Optometry, visit www.suny.edu.