Thyroid Eye Disease: DR Aleena Shah

Thyroid eye disease (TED) is an autoimmune disorder where IgG antibodies bind to TSH receptors, causing inflammation in the eye muscles, connective tissues, and orbital fat. Common symptoms include eyelid retraction, proptosis, diplopia, and optic neuropathy. Risk factors include smoking, female sex, and radioactive iodine treatment. Management involves lubricants, steroids, orbital decompression surgery, and in severe cases, corrective eye muscle surgery.

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Thyroid Eye Disease: DR Aleena Shah

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THYROID EYE DISEASE

Dr Aleena Shah
INTRODUCTION
1. Autoimmune disorder.

2. IGg antibodies binding to TSH Receptors.

3. More common in females.

CLINICAL FEATURES

1. Weight loss
2. Increased bowel frequency
3. Sweating
4. Heat intolerance
5. Irritability
6. Palpitations
7. Palmar erythema
8. Warm and sweaty s
RISK FACTORS

1.Smoking.
2. Women.
3. Radioactive Iodine can worsen TED.
PATHOGENESIS OF
OPHTHALMOPATHY
• Antibodies react against against thyroid cells and orbital fibroblasts.
• Leading to inflammation of
• 1.EOM
• 2.Interstitial tissues
• 3.orbital fats
• 4.Lacrimal glands

,
• Leads to increase in volume of intraorbital content,particularly muscles which increase 8 times leading to
increase in intraorbital pressure ,and compression of optic nerve.
CLASSIFICATIONS OF TED
• EUGOGO CLASSIFICATION(European group of Graves Ophthalmopathy)

1. Sight threatening………. due to optic nerve compression or corneal

breakdown.
2. Moderate to severe……. Lid retraction of 2 mm or more, diplopia and
proptosis of 3mm or more.
3. Minor……..with minor impact in daily life.
NO SPECS CLASSIFICATION

class Signs

0 No signs or symptoms

1 Only signs are upper eyelid retraction, lid lag, stare

2 Soft tissue signs and symptoms (edema of lids)

3 proptosis

4 Extraocular muscle involvement

5 Corneal involvement secondary to exposure

6 Sight loss secondary to optic nerve compression

CLINICAL FEATURES OF
TED
1. Soft tissue involvement.
2. Lid retraction.
3. Proptosis.
4. Restrictive Myopathy.
5. Optic Neuropathy.
SOFT TISSUE INVOLVEMENT

1. Conjunctival Hyperemia.
2. Periorbital Swelling.
3. Corneal Signs (Epithelial erosions and sup limbic
kerataoconjunctivitis).
4. Tear insufficiency.
SOFT TISSUE INVOLVEMENT
LID RETRACTION

1. Kocher Sign.
2. Dalrymple sign.
3. Von Graffe sign.
LID RETRACTION
PROPTOSIS
RESTRICTIVE MYOPATHY

Symptoms
Diplopia

Signs
Elevation deficit
depression deficit
Abduction deficit
Adduction deficit
OPTIC NEUROPATHY

V.A…..reduced.
Colour desaturation.
RAPD positive.
Visual Field defects.
Optic Disc Swollen.
INVESTIGATIONS
DIAGNOSIS

• Eyelid retraction with objective thyroid dysfunction

• Thyroid dysfunction is seen in 25 – 30% patients
• Thyroid hormone levels maybe elevated, normal or even low

• OR
• Eyelid retraction with objective thyroid dysfunction
• Exopthalmos
• Optic neuropathy
• Extraocular muscle involvement
MANAGEMENT
• Referral to endocrinologist
• Short term goals:
• Maintain useful vision
• Exposure keratopathy – lubricants, eyelid tapping, tarsorraphy
• Optic nerve compression- systemic steroids
• Diplopia- prisms , surgery

• Long term goals:

• Restore anatomy of orbit
• orbital decompression
TREATMENT
mild disease
1.lubricants
2.Topical anti inflammatory agents.
3.Head elevation to reduce periorbital edema.
4 Eyelid taping during sleep.
MODERATE TO SEVERE DISEASE
TREATMENT
1. Optic nerve compression treatment:
1. Systemic steroids.
2. IV methylprednisolone.
3. Radiotherapy
4. Combined therapy (steroids plus radiotherapy plus azathioprine)
POST INFLAMMATORY COMPLICATIONS

1. Proptosis
2. Restrictive Myopathy/ diplopia
3. Lid Retraction
PROPTOSIS

• Orbital wall decompression

1. One wall (lateral wall).
2. Two wall (Med wall and lateral wall).
3. Three wall (Medial, lateral, and floor).
4. Four wall(medial, lateral, floor, and superior).
RESTRICTIVE MYOPATHY