Thyroid Orbitopathy

What Does It Involve?

Thyroid orbitopathy is an immunological disorder that affects the thyroid gland and the orbital structures. This condition leads to the enlargement of the extraocular muscles and orbital fat, which causes proptosis (bulging eyes) or exophthalmos. It can affect the thyroid gland and orbital components either together or separately.

What Causes It?

Thyroid orbitopathy is most commonly associated with hyperthyroidism (excess thyroid hormone), but it can also occur in patients with hypothyroidism or even in those without any thyroid disease. The condition arises when specific molecules in the thyroid gland react with orbital tissue (extraocular muscles and orbital fat), causing inflammation.

How Can It Be Prevented?

Thyroid orbitopathy cannot be prevented. However, an ophthalmic evaluation at the time of diagnosing a thyroid problem or before receiving radiotherapy can facilitate early diagnosis and monitoring. This can help detect potential problems early and prevent complications.

The most significant risk factor influencing the progression of the disease is smoking. Therefore, it is crucial for patients to stop smoking after being diagnosed with a thyroid problem, even if their eyes have not yet been affected.

Symptoms

Thyroid orbitopathy typically has a poorly defined onset, with orbital inflammation manifesting through:

Eyelid swelling
Proptosis (bulging eyes)
Eyelid retraction
Strabismus (eye deviation) in some cases, usually without pain.

The progression and severity of the disease can vary widely. In some cases, it can threaten vision. The inflammatory activity typically lasts from a few months to two years, after which it stabilizes. Once stabilized, the disease is unlikely to reactivate.

Other common symptoms include:

Foreign body sensation
Ocular irritation and tearing due to corneal exposure
Double vision caused by strabismus
Decreased visual acuity due to compression of the optic nerve

Thyroid orbitopathy typically affects both eyes but can also present unilaterally or asymmetrically. It most commonly affects women between the ages of 40 and 60, and its progression is strongly associated with smoking.

In some cases, thyroid orbitopathy can occur before thyroid disease has been diagnosed.

Associated Treatments

The treatment for thyroid orbitopathy depends on the stage of the condition and the specific problems being experienced.

In early stages, when inflammation is prominent, the treatment focuses on protecting the ocular surface from dryness due to exposure. Anti-inflammatory treatments with corticosteroids are used if inflammation threatens vision.
In chronic stages, when inflammation transitions to muscle fibrosis and orbital fat enlargement, orbital decompression surgery is used to correct proptosis. If necessary, strabismus surgery and eyelid retraction surgery are performed to correct associated problems.

Surgical treatments are aimed at correcting proptosis, strabismus, and eyelid retraction to improve both vision and appearance.

Conclusion

Thyroid orbitopathy is a serious condition that can impact vision and quality of life. While it cannot be prevented, early detection and treatment, especially by avoiding smoking, can help manage the condition and prevent complications. Surgical interventions offer effective solutions for correcting proptosis, strabismus, and eyelid retraction in severe cases.

Thyroid Orbitopathy