Thyroid eye disease

Question 1

What eye symptoms do you get in Grave’s

Answer 1

1. Lid lag and lid retraction occurring due to excess sympathetic activity (not specific to Grave’s, but occur in thyrotoxicosis).
   
   2. Grittiness and redness
   3. Conjunctival oedema (chemosis)
   4. Periorbital oedema
   5. Proptosis and exophthalmos
   6. Ophthalmoplegia: due to orbital lymphocytic infiltration of the orbit and ocular muscles, causing diplopia.

Question 2

What are risk factors for thyroid eye disease in graves

Answer 2

• Smoking
• Male
• Increasing age
Radioiodine (eye disease is CI to Rx)

Question 3

How is eye disease treated

Answer 3

Restore euthyroid

Stop smoking

Mild: lubricant eye drops, tape lids,
Mod: steroids, immunosuppression

Question 4

When should patients be urgently referred to ophthalmology

Answer 4

○ Globe subluxation
		○ Loss of colour vision
		○ Sudden change in visual acuity
		○ Optic disc swelling
Severe conjunctival pain - corneal ulceration