Common Eye Disorders

Thyroid Eye Diseases

The eye is located in a bony socket known as the orbit. In addition to the eyeball, the orbit contains muscles (which move the eye), the optic nerve (which sends visual signals to the brain) and fat. In thyroid eye disease the amount of fat in the orbit increases and the muscles thicken. As a result of these changes, there is forward protrusion of the eyes. The protrusion stretches the optic nerve and, in extreme cases, may damage it. If the protrusion is too great, the lids may not cover the cornea and corneal ulceration may result. The muscles lose some of their functional ability due to abnormal thickening, possibly leading to squinting of the eye.

Thyroid eye disease occurs primarily in people suffering from thyroid disorders, which result either from excessive or diminished production of the thyroid hormone. However, some people may have this disease with a normally functioning thyroid gland. The disease usually occurs in middle age persons of 40-50 years. Women are more likely to be affected than men.

Cataract
IOL (Intra Ocular Lens)
Glaucoma
Diabetic Retinopathy
Squint
Amblyopia
Uvetis
Orbital Disorders
Thyroid Eye Diseases
Computer Vision Syndrome (CVS)

Symptoms

● Dryness of the eye

● Swelling of the upper and lower eyelids

● Frightened or staring look

● Forward protrusion of the eyeballs

● Inability to close the eye

● Decreased vision when optic nerve is affected

● Double vision and decreased eye movements when eye muscles are affected.

Investigations

The presence of thyroid eye disease is confirmed by orbital ultrasound. If this test cannot be performed, a CT scan may be required. In addition, any person suspected of having thyroid eye disease should undergo a blood test to ascertain whether the thyroid hormone level in the blood is higher or lower than normal.

Treatment

Treatment is essential to protect the cornea and the optic nerve from getting permanently damaged. In the initial stages of the disease, lubricating drops are used to keep the eye moist. Most patients must be started on steroid tablets for a few months to control the progression of the disease. Closure of the lids may be required if the lids are not able to completely cover the eyes. The closure is temporary and is done only on the outer part of the lids, leaving the cornea clear so that vision is not affected. If protrusion of the eyeball is too great the optic nerve is in danger. At this stage, orbital decompression is advised. This surgery involves breaking one or more walls of the orbit in order that the extra fat, which has been deposited in the orbit due to thyroid eye disease, may be displaced out of the orbit .

The eyeball can then be pushed back into the orbit. A patient who has suffered from thyroid eye disease for a long time develops eye movement disorders and requires eye muscle surgery to regain proper functioning of the muscles and to treat squint .

Risks of treatment

Steroid tablets may cause gastric irritation, weight gain, a puffy face, and interference with blood sugar control in diabetes. Therefore, these drugs are prescribed in as low a dose as possible. Only a few patients are not able to tolerate this small dose; in such patients surgery is advised. Orbital decompression surgery is safe, but in rare cases causes bleeding, infection, decreased eye movement, and loss of vision.

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