What is it?

It is an affectation of the orbit associated with an autoimmune thyroid disease. It goes by various names: endocrine exophthalmos, thyroid eye disease, thyroid orbitopathy, Graves ophthalmopathy or thyroid eye disease.

Various diseases can affect the thyroid. Those which affect its functioning as a producer of hormones are the most common causes. Hypothyroidism, produces a defect of activity, and hyperthyroidism excess. In the case of hyperthyroidism it is called Graves’ disease in honor physicians who described it in s. XIX.

Thyroid eye disease is an autoimmune disorder. This means that the immune system acts against certain cells in the body, in this case against tissues around the eyes (orbital fat, muscles that move the eyes or eyelids).

Symptoms

The first eye symptoms are mild and include dryness, redness, swelling of the eyelids, and inability to wear contact lenses. Often affects worse at night and under certain conditions, such as air conditioning, heating and on windy days.

Inflammation and edema affect the orbit and cause retraction of the eyelids, increasing openness and displacing the eye outwards, giving the appearance of “look of horror” (exophthalmos).

When the extrinsic muscles of the eye become inflamed, even if there is exophthalmos, they may lose motility resulting in double vision (diplopia) and strabismus. In severe cases these compressions create tension and altered vascularity on the optic nerve endangering vision.

In Graves Basedow disease eye symptoms usually occur while thyroid alteration, although it is variable. It is noted that most patients with Graves’ disease do not present orbital involvement and, if that would be the case, it would be mild.

Treatment

Inflammation and edema affect the orbit and cause retraction of the eyelids, increasing openness and displacing the eye outwards, giving the appearance of “look of horror” (exophthalmos).

When the extrinsic muscles of the eye become inflamed, even if there is exophthalmos, they may lose motility resulting in double vision (diplopia) and strabismus. In severe cases these compressions create tension and altered vascularity on the optic nerve endangering vision.

In Graves Basedow disease eye symptoms usually occur while thyroid alteration, although it is variable. It is noted that most patients with Graves’ disease do not present orbital involvement and, if that would be the case, it would be mild.

Prevention

Effective treatment of hyperthyroidism is no guarantee that the eye disease will improve, and no thyroid treatment can guarantee that the eyes will not continue to deteriorate. Once started, the disease of the orbit can remain active for several months and even years. Later, have a gradual and complete recovery. After a period of inactivity of six months, recurrence of ophthalmopathy orbit is rare. It is noted that orbital involvement is more common and more severe in smokers.