Last week, ELZA’s consultant oculoplastic surgeon, Dion Paridaens MD, PhD, who is also Head of the Oculoplastic & Orbital Service at the Rotterdam Eye Hospital and the Erasmus University Medical Center gave a lecture for the NVE Academy (Dutch Association for Endocrinology) about Graves’ Orbitopathy.
In the room were endocrinologists, internists, radiotherapists, thyroid surgeons and gynaecologists, who received an update on this endocrine abnormality that frequently has ocular complications. In addition to information about diagnostics, pathogenesis and classification, those present were introduced to new developments in the therapeutic field, including the latest surgical and medical treatment options for this condition.
Understanding Graves’ Orbitopathy
What is Graves’ Orbitopathy (GO)?
Graves’ Orbitopathy, also known as Graves’ Eye Disease (GED) or Thyroid Eye Disease (TED), is an autoimmune condition characterized by inflammation and swelling of eye tissues. This disease often relates to thyroid problems, primarily overactive thyroid glands due to Graves’ disease. However, it can occasionally manifest in individuals with underactive or normal thyroid function. Approximately 25% of people with Graves’ disease may develop GO at various stages of their thyroid disorder.
Key Features of Graves’ Orbitopathy:
- Inflammation leading to eye bulging or staring appearance
- Redness and swelling of eyes and eyelids
- Double vision due to misalignment of eyes
- Potential for blindness in severe cases
- Association with Autoimmune Response:
- The immune system’s attack on the body’s tissues causes the inflammation and scarring in GO, making it an autoimmune disorder.
Symptoms of Graves’ Orbitopathy
Common Symptoms:
- Bulging of the eyes
- Double or blurred vision
- Difficulty in eye movement
- Dry or watery eyes
- Sensitivity to light
- Pain behind the eye
- Redness and swelling of the eyes and eyelids
Urgent Symptoms Requiring Immediate Attention:
- Persistent blurred vision
- Noticeable change in color perception
- Rapid worsening of symptoms
Treatment Options for Graves’ Orbitopathy
Early Intervention:
- Prompt diagnosis and treatment are crucial in managing GO. The condition typically progresses for 6-12 months before stabilizing.
Mild Case Management:
- Artificial tear drops for dry eyes
- Selenium supplements
Severe Case Management:
- Steroids and/or orbital radiotherapy
- Surgery for lasting double vision or eye appearance changes
Surgical Options:
- Decompression surgery for more eye space
- Eye muscle surgery for severe double vision
- Eyelid surgery for appearance and function improvement
Additional Recommendations:
- Prism glasses for double vision
- High-dose steroids or radiation
- Support groups and counseling
Self-Care Measures:
- Quit smoking to improve treatment effectiveness
- Regular thyroid hormone level monitoring
- Adherence to prescribed medication
Impact of Graves’ Orbitopathy on Quality of Life
Graves’ Orbitopathy can significantly affect psychological and social well-being. Fluctuating thyroid levels can cause mood swings, anxiety, and irritability. Changes in eye appearance may lead to self-confidence issues. However, these symptoms often improve with appropriate treatment, including surgery. It’s important to seek support and guidance from healthcare professionals for managing these challenges.
