Thyroid Orbitopathy (Graves’ Disease)

Thyroid orbitopathy is an autoimmune inflammatory disorder of uncertain etiology that affects the tissues of the orbit (i.e. eyelids, extraocular muscles and other soft tissues surrounding the eyes). Patients with this disorder often have an associated thyroid abnormality which may manifest either before, during or after the orbital signs and symptoms. A small percentage of patients may have eyelid and orbital manifestations without developing a thyroid abnormality.

Thyroid orbitopathy can develop and affect patients with varying degrees of severity. The disease may begin suddenly and progress rapidly over days to weeks, or can start insidiously and progress gradually over a long period of time. The majority of patients have mild inflammation, the most common signs and symptoms of which are retraction of the upper and/or lower eyelids and bulging of the eyes. In cases with more moderate inflammation, patients may also have varying degrees of double vision and eyelid swelling as well as visible redness of the lids and eyes. A small percentage of patients with thyroid eye disease develop severe inflammation, which can result in compression of the optic nerve and permanent vision loss. In most cases, the inflammatory process is self-limited and runs a course lasting 6 months to a few years before subsiding. After the inflammatory phase of the disease subsides, scarring of eyelid and orbital tissues may result in the persistence of eyelid retraction, proptosis and double vision.

During the inflammatory phase of the disease, patients are usually evaluated on an interval basis to monitor progression of the disease and managed with measures to reduce ocular symptoms. Care is coordinated with the patient’s endocrinologist, who will manage concurrent thyroid abnormalities. Once the inflammatory phase of the disease has subsided, patients with eyelid abnormalities, double-vision or proptosis may be eligible for surgical correction to improve their function and appearance. It is important to note that cigarette smoking has been associated with worsening thyroid orbitopathy, therefore cessation of smoking is universally recommended in thyroid patients.

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