Thyroid Eye Disease Treatment
If you have symptoms of TED it is recommended that you are referred to an ophthalmologist who specialises in oculoplastics and has an in-depth knowledge of treating TED. The ophthalmologist will enquire about your eye and thyroid symptoms and will carry out a comprehensive eye examination. If you have double vision or there are signs on examination that your eye movements are restricted, you may be referred to see an orthoptist, who deals specifically with eye movement disorders.
You may be recommended to get an MRI scan of your eyes and eye sockets (orbits).
Mild Active Thyroid Eye Disease Treatment
- Most people who develop TED have mild disease, although it can still have a large impact on your quality of life and can cause significant distress.
- The mainstay of treatment for the mild disease is lubricant eye drops and/or anti-inflammatory eye drops.
- It is important that any coexisting thyroid disorder is treated effectively.
- There is a lot of evidence that smoking is associated with a greater chance of developing severe TED so smoking cessation is very important.
- There is limited evidence that Selenium supplementation (200 mcg daily) can help with some symptoms of TED.
More Severe Active Thyroid Eye Disease
If your TED is active and moderately severe then you will be offered treatment with high dose intravenous steroids, which is usually given over the course of weeks to months. This is arranged in conjunction with an endocrinologist. This is an effective treatment for reducing inflammation and decreasing the risk of long-term complications. There are potential side effects, which your doctor will discuss with you before starting treatment. Other treatment options are other immunosuppressive drugs and radiotherapy, although these are usually given in addition to or after steroid treatment.
Rarely, the inflammation is very severe and does not respond adequately to steroids, in which case you may require urgent surgery, called orbital decompression, in order to preserve your vision.
Sometimes the increased pressure behind the eye can cause increased pressure inside the eye. This may require treatment with eye drops to lower the pressure, to prevent glaucoma from developing.
Inactive, Stable Thyroid Eye Disease
Once your TED has become inactive, you may be left with some changes to your appearance and vision. At this stage, you may wish to have rehabilitative surgery. The type of surgery depends on how the TED has affected your eyes.
If your eyes are bulging forward, you may wish to consider orbital decompression, which involves removing bone and/or fat from the eye socket to increase the space behind the eye and allow the eye to settle back into the socket.
If you have double vision then you may be referred to a specialist to discuss squint surgery.
If your eyelids are retracted (wider open than normal) then you may undergo surgery to lower the upper lids or raise the lower lids.
If your main problem is excess fat or skin on your eyelids then you may have blepharoplasty surgery.
All these options can be discussed with your ophthalmologist.