Thyroid Eye Disease

Original article by Anthony Rimmer | Last updated on 7/6/2014
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Introduction

Typically associated with the signs of Grave’s disease (goitre, acropathy, hyperthyroidism and pretibial myxoedema).
Autoimmune orbital disease may occur without thyroid autoantibodies

Clinical features

  • Swelling of the eyelids
  • Oedema (chemosis) and engorgement of vessels of conjunctiva
  • Exposure of the cornea (loss of blink, apparent lid retraction)
  • Pronounced exophthalmos (if absent because tight orbital septum may restrain contents and lead to raised intraorbital pressure and optic nerve compression)
  • Restricted eye movements (infiltration of muscles by inflammatory cells, inflammation, oedema and fibrosis)
  • Optic neuropathy (fundal vascular congestion, swelling or atrophy of disc)

Management

Includes excluding or treating thyroid dysfunction, smoking cessation and artificial tears/ointments
o   Lid retraction can be reduced by guanethidine drops (relax smooth muscle)
o   If corneal exposure threatens sight, tarsoraphy performed.
o   In serious disease with corneal problems or pressure on CN II: high dose steroids, surgical orbital decompression and radiotherapy