Swelling of the eyes with thyroid disease
People with thyroid disease of the eye have suffered from a dysfunction of the thyroid gland in the past or will be in the future
Thyroid disease can affecteyes, as a result of which the muscles and soft tissues inside the orbit swell. This pushes the eyeball forward and causes various eye symptoms. Treatment includes measures to protect the eyes: the use of artificial tears, drugs, and in some cases even surgical intervention. It is also necessary to treat the disease of the thyroid gland itself.
Edema of muscles and adipose tissue of the eye
When in diseases of the thyroid glandeyes are affected, there is swelling of the muscles and fatty tissue surrounding the eyeball within the orbit (orbit). Edema is associated with inflammation of these tissues. Inside the orbit of the eye, space is limited, so when the tissues swell, the eyeball projects forward. This leads to the fact that the transparent window in the front of the eye (cornea) loses its protection. The eyeball can not move as easily as the muscles, now less control its work. When the disease is very severe, the nerve connections of the eyeball to the brain can be compressed and damaged. This period of swelling is accompanied by healing.
Thyroid eye disease also referred to as thyroid ophthalmopathy, dysteroid eye disease, ophthalmopathy or Graves ophthalmic disease.
Causes of thyroid eye disease
Thyroid gland is small in shapea butterfly-like gland that is located in the upper part of the throat (trachea) in front of the neck. It plays an important role in controlling the rate at which chemical reactions occur in the tissues of the body (metabolic rate). The thyroid gland can become hyperactive or depressed. This is most often associated with an autoimmune disease.
Autoimmune diseases and thyroid gland
The immune system usually creates small proteins(antibodies), which can attack foreign organisms (bacteria, viruses). In people with autoimmune diseases, the immune system produces antibodies against the body's own tissues. It is not yet clear why this is happening. Some people develop autoimmune diseases: their immune system attacks their own body tissues. Autoimmune thyroid disease (See article: Thyroiditis Hashimoto ) occurs when the body's antibodies attack the gland. In some people, these same antibodies can also attack the tissues surrounding the eyeball. This is a thyroid eye disease. It is not known why this happens in some people,but not in others. Therefore, thyroid disease of the eye is an autoimmune disease, which is most often associated with hyperactivity of the thyroid gland. In some cases, the thyroid disease of the eye occurs even when the thyroid gland is working normally. Nevertheless, people with thyroid eye disease, as a rule, suffered from a dysfunction of the thyroid gland in the past or they begin to have a disorder of this gland.
Prevalence of thyroid eye disease
This rare condition is diagnosed annuallyapproximately 16 women and 3 men out of 100,000 people. Most of these people have problems with thyroid hyperactivity, based on an autoimmune condition. This usually occurs in middle age. Some people have genes that increase the risk of a thyroid eye disease. In addition, this risk is increased in smokers.
Symptoms of a thyroid eye disease
Symptoms cause swelling in the orbital tissues andPush the eyeballs forward: 1) The eyes can become red and irritated, as the cornea is affected and poorly lubricated. 2) There may be dry eyes, as the development of tears with tear glands is impaired. 3) Eyes can hurt. 4) The eyes may look more prominent. 5) Double vision (diplopia) may develop, as the muscles become too swollen that does not allow them to work properly. 6) In the late stages of the disease, vision may become blurred, and colors may appear less bright. Two eyeballs are not always affected to the same extent.
Diagnosis of thyroid eye disease
The diagnosis can be put simply onexamination of the eye, if you already know about the disease of the thyroid gland. Sometimes blood tests are performed that are necessary to confirm the diagnosis. The level of hormones in the blood can show how well the thyroid gland functions. More specific blood tests can be done to measure the level of antibodies in the blood.
Thyroid ultrasound should be done toSee how actively it works. If the doctor is particularly concerned about swelling of the eye's orbit, he can prescribe an MRI that will determine which tissues are most affected. The doctor also needs to evaluate how well you see colors, as well as peripheral vision. An eye movement test can be performed, which will show which muscles were affected by the autoimmune process. These assessments should be carried out throughout the disease.
Treatment of thyroid eye disease
If the thyroid disease of the eye is not treated,Inflammation for several months or years should pass by itself. However, the symptoms caused by swelling (for example, bulging eyes) can remain forever, as some of the tissues that have been stretched can not always return to their original shape. The goal of treatment is to limit the damage caused during the inflammation period. For the treatment of thyroid eye disease, joint efforts of the ophthalmologist and endocrinologist are needed.
Preparations for the treatment of thyroid eye disease
At an early stage of the disease and when this diseaseflows in a soft form, artificial tears are applied, but they may not be enough. As the disease progresses, it may be necessary to use immunosuppressants - a family of drugs that suppress the immune system, which produces abnormal antibodies. Commonly used immunosuppressants are steroids, such as prednisolone. You also need to take some other drugs (omeprazole protects the gastric mucosa) to counteract some of the most common side effects of steroids. If you have a very serious illness, the doctor can prescribe a course of steroids injected through a dropper.
Surgical treatment of thyroid eye disease
Approximately 5 out of 100 people with thyroideye disease is a severe form of the disease, as a result of which the optic nerve (connecting the back of the eyeball to the brain) is compressed. This can damage the entire view. In this case, the doctor can decide on the organization of decompression. This is a procedure that creates space in the orbit for the spread of inflamed tissues. This reduces the pressure on the nerve. In some cases, a surgical operation can be performed, which allows to shift the eyeballs back. Sometimes an operation to eliminate stretched muscles allows you to return everything to its proper place. If there are problems with stretched tissues that need surgical correction after the inflammation has passed, the operation is done in orbit and then on the muscles.
Other types of treatment for thyroid eye disease
If dilation (diplopia) is developing, then the doctorcan prescribe modified glasses that block vision from one eye; or cover the eyes with a special prism to stop the diplopia. Radiation therapy (treatment by exposure to radioactive material) can be used for some people. The goal is to reduce the swelling in the eye. It is used along with other forms of treatment. There are a number of new treatments for thyroid eye disease that are being studied. In addition, the doctor will treat an anomaly of thyroid function. For this, drugs (radioactive iodine) or thyroid surgery will be prescribed.
Advice to patients with thyroid eye disease: 1) Smoking worsens the course of the disease, sogive up this bad habit. 2) A bright light can irritate the eyes, in which case sunglasses will be useful. 3) If you drive a car and have a dual vision, be sure to monitor it with prism glasses.
Complications of thyroid eye disease. Most people do not develop permanentcomplications. Nevertheless, they occur in some people, especially those whose treatment is delayed or with severe disease. More often complications occur in the elderly, as well as in smokers and patients with diabetes. Possible complications: 1) damage to the cornea; 2) constant strabismus or double vision; 3) damage to the optic nerve, which leads to decreased vision or color perception; 4) unsightly appearance.
Complications due to treatment: 1) side effects due to useimmunosuppressive drugs. 2) side effects due to surgery: double vision (in 15 of 100 people with thyroid disease of the eye); loss of vision (less than 1 in 1,000 people with a thyroid eye disease).
Thyroid eye disease is a prolongeddisease. The period of inflammation lasts from several months to several years (usually about two years). Nevertheless, in most people this disease proceeds in mild form and requires the use of only artificial tears, as well as regular examination of vision. Then this disease passes by itself. For patients with severe form of thyroid eye disease, the prognosis depends on how early the diagnosis is established and how intensively the treatment is carried out. Approximately 1 in 4 people eventually have low vision.