Thyroid Eye Disease


Patient with thyroid eye disease usually present with bulging eyes, double vision, watery eyes, red swollen eyes or reduced vision. It may present before they are diagnosed to have thyroid disease. While many have mild version of this condition, in some people it can progress rapidly and leading to significant reduction in vision, double vision and disfigurement.

There are two phases of this condition: active and quiescent phase. The active phase can last for 18 months but it is not that uncommon that it can be reactivated again after quiescent for years. Patients with active thyroid eye disease should see an oculoplastics surgeon to reduce inflammation and degree of severity of disease. When the eye has quieted down, surgery can be offered to improve double vision and restore facial appearance to its previous features.

severe proptosis (protruding of eyes) and double vision.

Provided Physiotherapies

Treatment

Depending on the activity and severity of disease, an individualised approach can be adopted. During the active phase, artificial eye drops, sunglasses, sleep with head upright will help to reduce the swelling. Steroid may be given depends on condition. Indiscriminate giving of steroid is not encouraged due to its significant side effect. Intravenous steroid is favoured over oral steroid for its efficacy and reduced side effects. For those who has double vision, it can be temporarily relieved with occlusion or prism. Surgery may be required in rare instance of active severe thyroid eye disease which threaten the vision.

During the quiet phase, surgery can be performed to correct the double vision, reduce bulging eye appearance or eye bags.

For the past few years, Dr Ho noted a link between emotional health with thyroid eye diseases, so with the diet may exert some influence on remission of this condition. Psychological counselling is provided or referral may be required if necessary. Advice on dietary intake is given as well.

Pre op:  Severe proptosis and deviated eye (Squint) secondary to restricted muscle.

Post op: Bilateral orbital decompression and hard palate graft to treat lower eyelid retraction.  Partial success in right eye due to development of cicatricialsclerosing and  response secondary to steroid.

Pre op and treatment:  This boy has bilateral proptosis (eyes protruding out) with lashes poking into eye (secondary epiblepharon).  He has thyroid dysfunction.

Post op:  This boy has a biopsy in the orbit as there are some some tissue density in the orbit.  The pathology showed inflammation.  With the biopsy and steroid, he showed remarkable improvement.  

Moderate thyroid eye disease with downward displacement of left eye despite oral steroid treatment.

Post local treatment :  the inferior displacement of eye has improved significantly. Unfortunately, patient decline treatment and hence 

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