Thyroid eye disease

Thyroid eye disease is an under diagnosed condition. Many patients are not diagnosed till late in the disease, when there are serious problems due to the disease. The eyes are usually red and congested. There is persistent watering from the eyes. The lids start to behave abnormally with widely open eyes which gives an angry look to the patient. The movements of the eyes can also get limited when the patient starts getting double vision. Protrusion of the eyes occurs due to the increase in fat in the orbit and enlargement of the eye muscles. The vision may drop when there is compression of the optic nerve by the eye muscles.

The serious manifestations are loss of vision and double vision. The treatment in the initial stages when the eyes are red is giving oral steroids or intravenous steroids so that the patient can tide over the inflammation or redness in the eyes.

Control of the thyroid status is also essential for the eye disease to become stable. For the double vision one can give prisms or even injection of botulinum toxin in the acute stages. Orbital decompression is needed if there is sight threatening optic nerve compression or for cosmetic reduction of the proptosis. Squint surgery may be needed for the double vision especially as there may be vertical displacement of images and adjustable sutures are used while performing the squint surgery.

I routinely perform surgery and manage many patients with thyroid eye disease, with a good outcome.