Thyroid ophthalmopathy is an autoimmune disease. Autoantibodies developed against the thyroid gland select all orbital contents except the eyeball as the target organ and initiate inflammation. The reason for the wrong target organ is the similar antigenic structure. Most of the patients are women over the age of 40. Although thyroid hormones are usually high, they can be normal or even low.

What Kind of Process Does Thyroid Ophthalmopathy Follow?

The disease lasts about 3 years with intermediate exacerbations. In the exacerbated period (soft tissue involvement period), the eyes of the patients are red and painful.

Image-1: Thyroid ophthalmopathy

In this period, the application of synthetic tears relieves the patients quite a lot. For a number of reasons, approximately half of the patients experience upper eyelid retraction (retraction). In this case, it is very important to bring the thyroid hormones of the patients to the normal level. If the retraction persists even though the hormone level is normal for 6 months, surgery should be planned. In orbital content; With cellular proliferation and increase in cell size, the eyeball is pushed forward (Exophthalmos). This situation creates serious cosmetic problems in patients. In addition, if the exophthalmos increases, it becomes difficult for the eyelids to close, and corneal drying occurs due to this.

What is done in the treatment of thyroid ophthalmopathy disease?

In patients with exophthalmos, steroids, immunosuppressives, immunomodulators can be used, and radiotherapy can be performed in patients who do not benefit from these. In cases where results cannot be obtained with these applications, the orbital walls should be chipped (decompression surgery). Patients may also complain of strabismus and diplopia due to the involvement of the eye muscles. If there is diplopia in the forward gaze and reading position, muscle surgery should be performed. Although very rarely, sometimes progressive vision loss may occur. In this case, it is necessary to perform decompression surgery to relieve the orbital contents.

Which Physicians Should Control the  Thyroid Ophthalmopathy Patients?

Graves' ophthalmopathy is a very important disease for eye health. Bad outcomes can be prevented with appropriate interventions. Patients definitely need a combined approach of different disciplines (multidisciplinary approach). If the management of the process is done well, no permanent problems will be encountered. Since interventions may be required on the eyelids, eye surface, orbital contents, and eye muscles, these patients need to be followed up by oculoplastic surgery and endocrinology for hormone changes.