Thyroid Eye Disease

Question 1

What is another name for it?

It can happen in euthyroid, hypothyroid and hyperthyroid** disease.

Answer 1

Thyroid ophthalmopathy

Question 2

How does it happen in Grave’s disease?

Answer 2

TSHR antibodies cause retro-orbital inflammation and lymphocyte infiltration

Question 3

What hyperthyroidism Rx may worsen it?

Answer 3

Radioactive iodine

Question 4

Symptoms:

What may happen to the eyes if they struggle to close them?

Why do they get diplopia?

Thyroid eye disease can cause swollen tissues around the eye that compresses the optic nerve.

• What symptoms would you expect? - 2
• What pupillary defect would you expect?

Answer 4

Gritty, dry and sore eyes

Strabismus in thyroid eye disease is a result of swelling and thickening of the extraocular muscles, which restricts eye movement and causes the eyes to move out of alignment. The resulting asymmetry between the two eyes can cause double vision (diplopia).

Photophobia
Reduced visual acuity - the blurring of vision

Relative afferent pupillary defect

Question 5

Signs:

What leads to exophthalmos?

How do you know someone has exophthalmos?

They get lid lag. Why?

What is ophthalmoplegia? Why does it occur?

What can exposure due to difficulty closing eyes cause?

What may be seen on fundoscopy?

Answer 5

Lid retraction

You can see the sclera above and below the eye

Both lid lag and lid retraction are attributed to the sympathetic hyperactivity of hyperthyroidism, which causes excess CONTRACTION of Müller muscle (the involuntary lid elevator whose paralysis causes the ptosis of Horner syndrome).

Diffuse eye muscle weakness - due to muscle swelling and fibrosis

Corneal ulceration or exposure keratitis

Papilloedema

Question 6

Tests:

What imaging is done to confirm it?

Answer 6

CT/MRI - look up

Question 7

Management:

TREATING UNDERLYING CAUSE IS THE MAIN THING!

What lifestyle factor, if stopped, would improve it?

Symptomatic relief:

• What can be done for dry eyes?
• What can be done to avoid exposure keratitis?
• What can be done to reduce periorbital oedema while sleeping?

In severe disease, what can be prescribed to reduce swelling and oedema?

What Rx for hyperthyroidism should be avoided?

Answer 7

Smoking

Artificial tears

Sunglasses
Avoid dust

Elevate bed when sleeping

Steroids

====

Radioactive iodine - can make it worse