Thyroid ophthalmopathy 02/06/2013

Thyroid ophthalmopathy is an autoimmune disorder in which the patient's own immune system attacks the thyroid gland and, in most cases, produces hyperthyroidism. The same antibodies that react against the thyroid also react against the orbital fat and extraocular muscles, leading to thyroid ophthalmopathy.

Signs and symptoms of thyroid ophthalmopathy 

Thyroid ophthalmopathy usually starts with a phase of active inflammation, typically lasting between six and twelve months, following by a stable phase in which the inflammation eases. The inflammatory phase of the ocular disorder usually coincides with the onset of hyperthyroidism, although occasionally ophthalmopathy can appear before or after the thyroid disorder.

Although it varies greatly in terms of severity and presentation, in the initial phase there's usually light sensitivity, a sensation of a foreign body in the eye, watery and reddened eyes. When the inflammation of the orbit tissue (fat and muscle) is greater, these swell and exophthalmos, lid retraction and strabismus appear.

There may be a loss of vision in a small percentage of cases as the swelling of the inflamed tissue presses on the optic nerve.

It's important to note that thyroid ophthalmopathy can evolve independently of a thyroid disorder. In other words, in some cases the ophthalmopathy can progress even when the thyroid function is under control.

Treating thyroid ophthalmopathy 

This needs to be treated from a multidisciplinary approach in which a specialised endocrinologist and ophthalmologist must treat the illness together.

Due to reasons that are not entirely understood, tobacco increases the risk of suffering complications in this illness and also the probability of the inflammatory phase recurring, so it is especially recommended to give up smoking.

While the inflammatory process lasts, and in slight and moderate cases, the use of collyria and ointment to lubricate the eye's surface are recommended. In some cases patients with severe inflammation or complications, such as sight loss, may require intravenous treatments with corticosteroids or other immunosuppressant drugs.

Once the inflammatory phase has passed, many patients will return to normal and will not require any further treatment. Patients suffering from permanent repercussions such as exophthalmos, eyelid retraction or strabismus will require surgery to return to normal.