Thyroid eye disease (TED) affects many people dealing with abnormal thyroid function. Characterized by symptoms such as tearing, discomfort, eye bulging, double vision, and even loss of vision, the disease can significantly impact quality of life.
With many treatment options available — ranging from medications to surgical interventions — patients are frequently faced with the question: Can thyroid eye disease be reversed? Understanding the intricacies of this disease and the effective treatments is crucial for anyone navigating this journey.
What Is Thyroid Eye Disease?
Thyroid eye disease (TED), also known as Graves’ ophthalmology, is a complex autoimmune condition. This disease is often associated with thyroid dysfunction, in which the immune system mistakenly attacks the thyroid gland, resulting in an abnormal production of thyroid hormones. This can cause the immune system to attack orbital fibroblasts (cells around and behind the eye that help regulate immune response and other functions), leading to inflammation, swelling, and tissue changes around the eyes.
Thyroid eye disease falls under neuro-ophthalmology and oculoplastics, ophthalmic subspecialties that involve the study of visual problems related to the nervous system, and diseases of the orbit.
What Does Thyroid Eye Disease Look Like?
Thyroid eye disease presents a range of symptoms that can affect the eyes and surrounding tissues.
Bulging Eyes (proptosis): The eyes protrude forward due to inflammation and swelling. This protrusion can lead to an increased exposure of the cornea, potentially causing dryness and irritation.
Double Vision (diplopia): Double vision, known as diplopia, may occur if the eye muscles are affected and no longer work in tandem.
Eyelid retraction: The upper eyelids elevate higher than normal (and the lower lids are pulled lower than normal) due to an imbalance in muscle function, creating a wide-eyed appearance.
Redness and puffiness: Inflammation and tissue changes around the eyes can cause redness and puffiness.
Dryness and irritation: Inflammation and swelling can affect tear film production and distribution, leading to a disruption in the natural lubrication of the eyes.
Eye pressure: The circulation of fluid within the eye may be disrupted, leading to an imbalance between the production and drainage of fluid. This imbalance can result in a build-up of pressure within the eye, called elevated intraocular pressure. This can lead to glaucoma.
Strabismus (crossed eyes): Inflammation and swelling around the eyes can affect the extraocular muscles, leading to misalignment.
Optic neuropathy: In severe cases, swelling and inflammation can compress or damage the optic nerve, leading to decreased vision, changes in color vision, and loss of peripheral vision.
How do you Treat Thyroid Eye Disease?
The treatment options for thyroid eye disease focus on managing the symptoms and addressing the underlying causes to improve eye health and quality of life. There is a variety of treatments that aim to control the condition and alleviate its effects.
Can Symptoms Go Away on Their Own?
Symptoms can sometimes improve on their own and may only last a year or two. However, some people may continue to have persistent symptoms that require ongoing management.
The disease progresses through two phases: active and inactive.
- Active phase: Inflammation and swelling occur, and this phase can last from several months to up to two years. Eye bulging, redness, irritation, and double vision may be more pronounced. Active management and treatment are often necessary to control symptoms and prevent complications.
- Inactive phase: Symptoms may enter a stable phase where inflammation subsides, and symptoms may stabilize or improve. However, some changes, like eyelid retraction, eye bulging, and double vision might persist and require surgical intervention for correction.
How to Manage Symptoms
Options to manage symptoms of thyroid eye disease include over-the-counter and prescription medications, lifestyle changes, and potentially surgery.
Medications: Teprotumumab is a monoclonal antibody drug specifically made to treat thyroid eye disease. The drug targets and inhibits the insulin-like growth factor-1 receptor (IGF-1R), which can be overexpressed in eye tissues and contributes to TED symptoms. In addition, corticosteroids (lab-made versions of hormones produced by the adrenal gland) help reduce inflammation and swelling around the eyes. Rituximab, a type of cancer drug, targets proteins on white blood cells to treat inflammation.
Over-the-counter eye drops: Artificial tears or lubricating eye drops are a top choice to treat dryness and irritation. Over-the-counter gels and ointments may also provide relief.
Surgical interventions: The surgery used depends on the specific needs of the patient. Eyelid surgery can address eyelid retraction or other eyelid issues. Orbital decompression surgery helps relieve pressure on the optic nerve and reduces eye bulging by creating more space in the eye socket. Eye muscle surgery addresses eye misalignment (strabismus) and double vision.
Radiation therapy: Controlled doses of radiation work by damaging the DNA of the overactive immune cells that are causing the inflammation. Radiation takes several sessions to administer and is typically used in conjunction with steroids.
