Thyroid eye disease (TED) is an autoimmune condition that affects the muscles and fatty tissue surrounding the eye within the bony orbit leading to congestion with risk of vision loss.
It is most commonly associated with overactive thyroid, but it can present in patients with normal or underactive thyroid. Thyroid eye disease has an active phase of inflammation and a quiescent phase of scarring formation. Smoking increases significantly the risk of developing TED but also makes its course much more severe.
The symptoms of TED can include ocular irritation, watering, eyelid puffiness and swelling, bulging eyes, double vision and eye pain.
Most cases of TED are mild and self-limiting, so conservative treatment including lubricating eye drops and selenium supplements are recommended. Quitting smoking and keeping the thyroid function under control are extremely important to improve the course and the prognosis of TED. Cases with severe active inflammation are treated with high-dose steroid infusions and additionally orbital radiotherapy. This treatment can prevent vision loss and improve the congestion within the orbit. In unresponsive patients urgent decompression of the orbits is required.
Surgery in TED aims to restore the cosmesis. Orbital decompression is carried out to improve the eye bulging. Subsequently squint surgery is performed to restore the eye movements and improve any double vision. Lastly eyelid surgery is performed to correct the eyelid position that is very often affected in TED.