Thyroid eye disease

Treatment

Treatment for exophthalmos (bulging eyes) largely depends on what is causing the problem.

In some cases, an ophthalmologist (eye specialist) may feel immediate treatment isn't necessary. You may only be advised to have regular examinations to monitor your condition.

Treating thyroid eye disease

If you have thyroid eye disease, your treatmentmay involve several different stages. This is because the condition tends to progress through two main phases:

an "active" phase when symptoms caused by inflammation of the eyes, such as dryness and redness, are prominent and you may be at risk of vision problems
an "inactive" phase when the condition has "burnt out" and many of the symptoms settle down, but you may be left with some long-term problems (including protruding eyes)

Typically, the initial active phase lasts for between several months and around two years.

Some of the main treatments you may be offered if you have thyroid eye disease are described below.

Correcting thyroid hormone levels

If you have an overactive thyroid gland (hyperthyroidism) or an underactive thyroid gland (hypothyroidism) , you'll usually be offered medication to help correct the level of thyroid hormones in your blood.

For example, an overactive thyroid can be treated with medication such asthionamides,which prevent your thyroid gland producing excess amounts of thyroid hormones.

Treating your thyroid problems will not necessarily improve your eye-related symptoms, but it may help prevent other problems associated with abnormal thyroid levels. It may also help the problems affecting your eyes from getting worse.

These include:

stopping smoking if you smoke, as it can significantly increase the risk of eye problems becoming more severe
raising the head of your bed for example, using extra pillows whichmay help reduce some of the puffiness around your eyes
wearing sunglasses if you have photophobia (sensitivity to light)
trying to avoid exposing your eyes to irritants such as dust
using eye drops to help relieve soreness and to moisten your eyes if you have dry eyes
wearing glasses containing special prisms designed to help correct double vision

If your thyroid eye disease is mild, these measures along with the medications to correct your thyroid hormone levels mentioned above may be all the treatment you need.

Corticosteroids

In more severe cases,when the eyes are particularly painful and inflamed during the active stage of thyroid eye disease, corticosteroids may be recommended by your doctor.

Corticosteroids are powerful medications that can help bring the inflammation associated with thyroid eye disease under control. Theycan help ensure the condition is stable before any type of surgery (see below) is considered.

In many cases,corticosteroids given directly into a vein (intravenously) are recommended. This is because taking corticosteroid tablets over a long period of time can have significant side effects.

A typical course of treatment with intravenous corticosteroids involves weekly treatments over a 10-12 week period. You should start to notice an improvement in your condition after a week or two.

Severe side effects of intravenous corticosteroids are uncommon, but you may experience some short-lived problems for a few days following the treatment sessions, such as:

feeling agitated
having difficulty sleeping
headaches
blushing of the neck and face

It may also be combined with corticosteroids.

This treatment useshigh-energy radiation, usually X-rays , to destroy cells. Low doses of radiation can be used on thetissues and muscles in the eye socketto help reduce the swelling.

Duringtreatment, you'll lie down and a special shell will be placed over your head to keep it still. A machine is used to carefully direct beams of radiation at the area being treated.

This is usually done on an outpatient basis, which means you won't need to stay in hospital overnight. Treatment typically involves around 10 sessions over a two-week period.

Radiotherapy can cause some side effects, although these should be minimal as the treatment will be confined to a specific area and shouldn't affect other parts of your body. However, possible side effects may include:

short-term worsening of your eye symptoms
cataracts
in rare cases, sight-threatening retinopathy (damage to the layer oftissue at the back of your eye)

Surgery

In some cases, surgery may be considered as a treatment for exophthalmosif you have severeor persistent symptoms.

For example, surgery may be considered to improve the appearance of the eyes ifexophthalmoshas been in the inactive phase for a few months. Medical treatment alone won't necessarily reverse the protrusion of the eyes.

Surgerymay also be carried out during the active phase of thyroid eye disease if there's an immediate threat to your vision due to compression of theoptic nerve (which transmits signals from the eye to the brain).

Surgery may also be effective if the exophthalmos is caused by other problems, such as issues with the blood vesselsbehindthe eyes.

Types of surgery

There are three main types of surgery that may be carried out on people with exophthalmos, although it's unusual for someone to have all three. These are:

orbital decompression surgery (see below) wherea small amount of bone is removed from your eye socket(s)
eyelid surgery where surgery iscarried out to improve the position, closure or appearance of the eyelids
eye muscle surgery where surgery is carried out on your eye muscles to bring your eyes into alignment and reducedouble vision

These procedures are usually carried out under general anaesthetic , which means you'll be asleep. Depending on the type and extent of the operation you have, you may need to stay in hospital for up to a few days afterwards.

Orbital decompressionsurgery

Orbital decompression surgery is most often carried outto improve the appearance of the eyes of people with thyroid eye disease who are affected by exophthalmos. It may also be required to reduce any pressure on the optic nerve.

During the procedure,a small amount of boneis removed from your eye sockets (orbits) andsome of the fat surrounding the socket may also be removed.

This allows any excess tissue that's pushing the eyeballs forward to move down into the space below. It also allows your eyes to sit further back in your head, so they don't protrude forward as much.

This procedure is carried out under general anaesthetic and normally involves making incisions near whereyoureyelids meet in the inner corner ofyoureyes (the point nearest the nose). You may need to stay in hospital for a day or two after this procedure, so your recovery can be closely monitored.

Possible complications that can occur following orbital decompression surgery include:

persistent double vision
a build-up of blood in the eye socket (haematoma)
infection where the incision is made

If you're considering having orbital decompression surgery, ask your doctor or surgeon to explain the benefits and risks of the procedure to you.

Treating other causes of exophthalmos

For most other problems that cause exophthalmos, treatment will vary, depending on the underlying cause.

For example, if you have an infection affecting the tissue in your eye socket, such as cellulitis , your ophthalmologist may prescribe antibiotics to treat the infection. They may also need to carry out a procedure to drain any abscesses that have developed.

If you have a tumour behind your eye, your doctors will discuss treatment options with you. For most types of cancer, treatment involves one or more of the following: