source: Ophthalmology Times

year: 2022

authors: Lynda Charters

Thyroid eye disease (TED) is a rare autoimmune condition that is associated with Graves disease and is vision-threatening, making its identification all the more important, according to Gary Lelli, MD, vice chairman of ophthalmology at Weill Cornell Medical College in New York, New York.

Although this association is recognized, TED and Graves disease are 2 separate entities. “The TED component,” Lelli said, “can occur in up to 50% of patients with Graves disease, but also in hypothyroid and normal thyroid levels.”

In addition, TED occurs much more often in women—that is, as much as 5 times more often—and more in the fourth decade of life. A second peak can occur in older patients in their sixth decade of life.

In addition, smokers are much more likely to develop TED and have a longer period of inflammation from TED as well as a more severe disease course. The inflammation that develops in TED around the eye and eye socket can cause progressive changes, resulting in functional vision disorders, patient discomfort, and changes in patient appearance over relatively short periods of weeks to months, Lelli explained.

A menu of symptoms accompanies TED, such as severe dry eye, ocular redness and irritation, ocular bulging, eyelid retraction, and blurry vision. The characteristic inflammation associated with TED can impact the ocular muscles, resulting in diplopia and a detrimental effect on daily activities, such as reading and driving.

In the most severe cases, inflammation can cause compression of the optic nerve, resulting in visual loss. This most severe result can occur in approximately 2% to 5% of patients. Inflammation also can affect the normal fat behind the eyes and cause hypertrophy. This scenario is involved with ocular bulging. Swelling that is related to the fat hypertrophy also can be apparent in the lower and upper eyelids.

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