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, an eye specialist may prescribe antibiotics to treat the infection. They may also need to drain any abscesses that have developed.
If you have a tumour behind your eye, your doctor will discuss treatment options with you. For most types of cancer, treatment involves one or more of the following:
- chemotherapy â where medicine is used to kill the cancerous cells
- radiotherapy â where radiation is used to kill the cancerous cells
- surgery to remove the cancerous tumour
Other Types Of Treatment
If you develop double vision , you may be referred to a specialist health professional who manages problems with eye muscles . They may give you modified glasses that block off vision from one eye or put a special cover, called a prism, over one side to stop the diplopia.
Treatment using radiation may be used in some places on some people. The aim is to reduce the swelling in the eye. It is used alongside other forms of treatment.
A number of new treatments are being investigated.
Your doctors will also treat any abnormality of thyroid function with antithyroid medicines. This is usually with tablets but may also include radioactive iodine or, uncommonly, surgery to the thyroid gland. We know that good control of the thyroid function helps lessen the severity of thyroid eye disease. See the separate leaflet called Antithyroid Medicines.
What Are The Longer
With the correct treatment, thyroid eye disease can be well managed and patients can live full and active lives. Most of the effects of the thyroid eye disease will settle with time and when thyroid function is stabilised. Patients taking carbimazole tablets to treat hyperthyroidism may need to take them daily for life, although definitive treatment of the overactive thyroid gland with radioiodine or surgery is generally preferred, once the eye disease has settled down. Regular blood tests should be carried out to monitor thyroid hormone levels and the dose of carbimazole adjusted accordingly. However, there are other treatment options such as thyroidectomy or radioiodine treatment that can be considered once the eye disease has settled down.
The changes in the physical appearance of the eyes can have a psychological effect on the individual, causing low self-esteem. The long-term consequences of the disease, even after the thyroid has settled down, may be difficult to accept. Some patients may have a permanent change to their appearance, which may require surgery. Very rarely, there is a permanent loss of vision this can happen if the disease is left untreated at the sight-threatening stage.
Patients should stop smoking as this is known to aggravate the condition. Sunglasses may be necessary even when indoors. If double vision is not corrected, driving will be dangerous. Patients should discuss any concerns with their doctor.
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Thyroid Symptoms And Conditionsexplained
While all of this viral activity is happening in the thyroid, you may be highly aware that something is amissand even have received a thyroid-related diagnosisor you may not know that thyroid issues are throwing your life out of balance. Thats because as in Stages One and Two of EBV, the symptoms of Stage Three EBV can be either subtle or overwhelming. Much of this has to do with which strain of Epstein-Barr you happen to have; there are over 60 varieties of it, some of them slow-moving and mild, others accelerated and aggressive. As you continue to read, I hope youll find insight into your individual struggle so you can solve the mystery and move forward.
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How Can The Long
In most people, the active inflamed stage of TED resolves within about two years. In a few people, active TED can recur again after it has burnt out, although this becomes less likely the longer that the condition has been inactive.
Treatment after TED has burnt out is aimed at dealing with any remaining double vision, providing better eyelid protection for your eyes and improving the appearance of your eyes.
The swelling caused by TED can often improve once the active stage has passed, meaning there can be some improvement in the appearance of your eyes. However, you might be left with some changes caused by the swelling, such as eyelid retraction , exophthalmos , large eyelid bags or double vision. This is because the tissues that have been inflamed are often less flexible once the active phase of the condition has passed, and theyre not able to return to their original position.
If this is the case, then you may wish to decide whether or not to have further surgery to help improve these changes. Sometimes the problems that are left may only be minor and you may feel treatment is not necessary, or that the risks of the surgery outweigh the problems that you have.
For more information on how TED affects your sight and the available treatments, .
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How Is Thyroid Eye Disease Treated
It is important to keep the thyroid function stable. The treatment will depend on whether the thyroid gland is overactive or underactive. An overactive gland is treated with anti-thyroid tablets, usually carbimazole or occasionally propylthiouracil, to treat the raised hormone levels. These act on enzymes in the thyroid gland to reduce production of thyroid hormones. In the case of an underactive gland, thyroxine replacement tablets will need to be taken daily for life .
Smoking is the biggest external factor known to make the disease worse and it is important for affected people to stop smoking immediately.
Symptoms of thyroid eye disease should be treated as they happen. These can include:
dry eyes use of artificial liquid tears can help eyes not closing at night ointment, eye pads and taping the eyelids closed can help to keep the eye moist and protected swelling around the eyes raising the head further at night with the help of extra pillows or raising the head end of the bed may help double vision use of special glasses with prisms can help; after the disease has settled down, eye muscle surgery can correct residual double vision deteriorating vision or worsening prominence medications such as steroids or steroid-like medications are used to reduce the swelling. They are usually used at a high dose to start with and continued for a long time. Radiotherapy to the tissues behind the eyes is also effective but takes several months to work.
How Is Thyroid Eye Disease Diagnosed And Monitored
Thyroid eye disease is often diagnosed after a diagnosis of Graves disease. For example, if you see your primary care physician for an annual exam, you might also get lab work done that checks your thyroid function.
If youve been experiencing symptoms of hyperthyroidism heat intolerance, trouble sleeping, rapid heartbeat, diarrhea, unintentional weight loss, or irritability, according to the National Institute of Diabetes and Digestive and Kidney Diseases ; that would also prompt your doctor to order thyroid testing.
Keep in mind that Graves disease is only one cause of an overactive thyroid. If you are diagnosed with Graves, you should have a baseline eye exam done with an ophthalmologist, who can monitor your eyes for any developing problems.
Less often, people will develop eye problems before they develop thyroid abnormalities, says Kossler. The eye disease may even appear when the thyroid is not overactive, making it even more complicated, according to NORD.
Thyroid eye disease is commonly misdiagnosed, says Kossler. It can take moderate or severe disease before its correctly diagnosed. If you notice common signs and symptoms, such as eye pain, redness, swelling, or your eyes changing appearance, she recommends seeing an ophthalmologist to get lab work done to rule out thyroid eye disease.
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Are There Any Complications From Thyroid Eye Disease
Most people do not develop permanent complications. However, where treatment is delayed or where the thyroid eye disease has been severe, there can be lasting effects. They are also more likely in older people, in those who smoke and in people with diabetes. Possible complications include:
Complications from the disease
- Damage to the clear window of the eye .
- Permanent squint or double vision .
- Damage to the nerve of the eye, resulting in poor vision or colour appreciation.
- Altered appearance .
Complications from treatment
- Side-effects from the immunosuppressive medicines.
- Side-effects from the surgery:
- New double vision .
- Loss of vision .
- There are some other very rare complications that your surgeon will talk you through.
What Is The Outlook For Thyroid Eye Disease
Thyroid eye disease is a temporary but drawn-out illness which fades away by itself. The inflamed period tends to last months to years , after which there is a healing response. For most people the condition will be mild, needing lubricants and regular assessments only. For those with more severe disease, the outlook depends on how early it is diagnosed and how intensive the treatment is. About 1 in 4 people with severe disease will end up with reduced eyesight.
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How Quickly Does Thyroid Eye Disease Progress
There are two phases of Thyroid Eye Disease. The first phase is called the acute phase, or active phase when symptoms are apparent. The second is called the chronic phase, or the inactive phase when there are few or no symptoms.;
Thyroid Eye Disease begins with the;acute phase, when symptoms appear suddenly and usually worsen quickly. Redness and swelling and scarring start to form during this phase and can damage your eyes and cause a number of other changes. As soon as you notice any symptoms, contact your specialist to schedule a thorough eye exam before any eye damage can be done.;
Would you like to talk with someone about TED? Contact us today at to schedule an appointment.
It Just So Happened That Historically The Incubation Period For Ebv Was Such That It Started To Infect The Thyroid And Cause Symptoms At The Same Time A Womans Menstrual Periods Were Stopping And The Coincidence Was Mistaken For Causation
The classic menopause symptoms I listed above are not actually due to menopause. Theyre signs that something else is amiss in the body, often due to radiation or pesticide exposureor the virus Epstein-Barr. It just so happened that historically, the incubation period for EBV was such that it started to infect the thyroid and cause symptoms at the same time a womans menstrual periods were stopping, and the coincidence was mistaken for causation. These days, with more aggressive, faster-developing strains of EBV showcasing themselves, women are coming down with hypothyroidism earlier in life, and now its not uncommon for 25-year-olds to receive diagnoses of perimenopause. This is a mistake that leaves so many young women in an identity crisis, feeling like theyre growing old before their time, when in reality, the problem is viraland manageable.
This is critical information for you to hold close, because current medical explanations of hormonal imbalance and thyroid disease leave countless patients feeling that their bodies arent to be trusted. They feel betrayed, faulty, weakwhen in fact, its just the opposite. Your body fights for you. Your body is on your side. Your body loves you unconditionally. It just happens to be up against a pernicious adversaryone that can be tamed with the right approach.
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How Do Health Care Professionals Diagnose Eye Floaters
When a patient goes to the ophthalmologist with the symptom of eye floaters, the doctor will first ask the patient questions about them. The ophthalmologist will check the patients central and peripheral vision, look at the front of the eyes with a slit lamp, and then place drops in the eyes to dilate the pupils. After the pupils are dilated, the retina and vitreous will be examined with bright lights from an ophthalmoscope mounted on the head of the doctor. The ophthalmologist will be able to see the eye floaters themselves and will be able to tell the patient whether there are any associated abnormalities that require further tests or treatments.
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How Thyroid Eye Disease Is Treated
Ami A. Shah, MD, is board-certified in ophthalmology. She works for Kaiser Permanente and is the owner and founder of one of the Bay Areas first mobile aesthetic practices.
Thyroid eye disease affects the muscles and tissues of your eyes. It is caused by an overactive thyroid from Graves disease. You may need to see specialists such as ophthalmologists, endocrinologists, internists, surgeons, and other healthcare providers to receive treatment for this condition.
First, your doctor will want to treat your Graves disease with medications, radioiodine therapy, or thyroid surgery. Managing your overactive thyroid is important for your eye health. Sometimes treatment for Graves disease is not enough to help with thyroid eye disease, so you will need additional treatments, including lifestyle, over-the-counter , prescription, and surgical options.
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Alleviating Symptoms With Medication
Drugs For Thyroid Eye Disease
In 2020, the U.S. Food & Drug Administration approved a new drug to treat thyroid eye disease. The drug, Tepezza , may significantly reduce eye-bulging and may improve or eliminate double vision in TED patients.
Doctors also use corticosteroids such as prednisone to reduce the inflammation and swelling caused by moderate to severe thyroid eye disease. However, steroids generally will not reduce eye-bulging or correct double vision.
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Who Is At Risk For Thyroid Eye Disease
Thyroid eye disease is most commonly associated with Graves disease. It can also occur with normal thyroid hormone levels or low levels of thyroid hormones .
Other risk factors for thyroid eye disease include:
- Age: Usually affects middle-age adults but can occur at any age
- Gender: Females are affected more than males
- Family history of thyroid eye disease
- Smoking: Smoking increases the risk of thyroid eye disease by 78 times, causes thyroid eye disease to have a longer active phase, and it reduces the effectiveness of treatments
- Radioactive iodine therapy: Radioactive iodine has been used to treat hyperthyroidism and Graves disease. This treatment should be used with caution in people with active thyroid eye disease as it may worsen the condition unless steroids are given at the same time
- Low blood levels of selenium, a dietary mineral.
Finally Effective Potential Treatment To Reduce Symptoms Of Thyroid Eye Disease
As many as 20,000 individuals will experience thyroid eye disease; in any given year; and by some accounts, it may occur in up to 50% of patients with Graves disease and in an estimated 4% of those with Hashimotos thyroiditis.2 The main symptoms in active disease include: proptosis, inverted eyelids, dry eyes, excessive tearing of the eyes, double vision, strabismus, and in the most serious cases, vision loss.
In seeking the first therapeutic agent to confer relief of symptoms associated with thyroid-associated ophthalmopathy, participants were randomized to receive either the biologic or a placebo every three weeks by infusion over the course of 24 weeks; the net number of treatments were eight infusions.3;Initial dosing was 10 mg/kg, which was titrated to 20 mg/kg for the second dose then kept constant for the duration of the study. This human monoclonal antibodyteprotumumabacts by targeting the insulin-like growth factor I receptor .
At the outset, all enrolled patients presented with a severe form of active thyroid eye disease, characterized by significant orbital inflammation. Dropout rates were considered low with 79 patients completing the phase 3 study, and 82.9% of those in the drug treatment group meeting the primary outcome of at least a 2 mm reduction in proptosis,1,3;said Dr. Douglas.
The phase 2 trial that also showed significant reduction in proptosis response , and clinical activity scores were similar in both studies,3,4 he said.
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Management Of Systemic Hyperthyroidism
The following section starts with an overview of managing hyperthyroidism, followed by the different treatment options used in TED. It concludes with a discussion about therapeutic modalities specific to each sign or symptom associated with TED.
Figure 23: Anti-thyroid drug mechanisms. This diagram depicts the formation of thyroid hormone, as well as the mechanism of action of anti-thyroid drugs to decrease levels of circulating thyroid hormone.