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by Mary Shomon

There are many different names you might find for the autoimmune eye condition that is often seen with thyroid disease, including:

• Thyroid Eye Disease, sometimes abbreviated as TED
• Graves' Opthamolopathy
• Thyroid-associated orbitopathy (TAO)
• Grave's orbitopathy

Thyroid Eye Disease is an autoimmune eye condition that, while separate from thyroid disease, is often seen in conjunction with Graves' Disease. The condition, however, is seen in people with no other evidence of thyroid dysfunction, and occasionally in patients who have Hashimoto's Disease. Most thyroid patients, however, will not develop thyroid eye disease, and if so, only mildly so.

Signs and Symptoms of Thyroid Eye Disease

Signs and symptoms include:

• Pain in the eyes, pain when looking up, down or sideways
• Dryness, itching, dry eyes, difficulty wearing contact lenses
• Inflammation and swelling of the eye, and its surrounding tissues
• Swelling in the orbital tissues which causes the eye to be pushed forward -- referred to as exophthalmos -- which can make Thyroid Eye Disease sufferers appear to have a wide-eyed or bulging stare.
• Bloodshot appearance to eyes
• Double vision (doctors call it diplopia)
• Impaired vision

Smoking and Thyroid Eye Disease

It has been noted that the eye disease develops more frequently and is more severe among women who smoke. See Smoking: The Little Known Links to Thyroid Disease.

According to a Jan. 27, 1993 article in the Journal of the American Medical Association, smokers are twice as likely as nonsmokers to develop Graves' disease. According to that article, smoking also apparently worsens eye problems in people with Graves' disease.

Researchers have also recently learned that smoking reduces the effectiveness of treatments for thyroid eye disease. The researchers reviewed the outcomes of 300 Graves' disease patients with mild eye symptoms treated with radioiodine alone or with steriods, and 150 with serious eye complications who received steroids and radiation therapy for their thyroid eye disease.

Among Graves' disease patients who had milder eye symptoms, smokers were more likely to progress to more serious thyroid eye disease than nonsmokers. Radioidone and steroid treatment for thyroid eye disease was also four times more effective in dealing with the eye symptoms for nonsmokers than smokers. This same relationship also applied to patients with more serious thyroid eye disease. ("Smoking affects Graves' disease treatment," Annals of Internal Medicine, 1998;129:632-635.)

Treatments

In milder cases of Thyroid Eye Disease, often all that is needed is lubricating eye drops or ointments for moisture, wraparound sunglasses to avoid glare, bedroom humidifiers to reduce dry eye problems. When double vision occurs, some patients respond to the addition or prism lenses in their eyeglasses. For pain, swelling and redness, short courses of the steroid prednisone are sometimes prescribed. Symptoms often return after the course of prednisone therapy, however.

Some doctors recommend orbital radiation, which can be successful in some patients.

In rare cases, when medical treatment has not resolved the retracted and puffy eyelids, or double vision, doctors will recommend corrective surgery. For some good before and after pictures of Thyroid Eye Disease surgery results, see the Eyelid-Doc.com website.

Eyelid surgery is primarily cosmetic in nature, and is designed to bring the eyelids into a more normal position, to improve appearance.

Surgery for double vision works with the muscles that control eye movement.

In a very small percentage of patients, the swelling in the orbital area impairs vision by pressing on the optic nerve. In these cases, a surgery called orbital decompression is needed in order to prevent severe complications.

The Issue of Radioactive Iodine Treatment (RAI) for Graves' Disease

Radioactive Iodine (RAI) treatment is the preferred treatment in the U.S. for Graves' Disease and its resulting hyperthyroidism. According to the New England Journal of Medicine, however, radioiodine therapy for Graves' hyperthyroidism is more likely to apparently cause or worsen Thyroid Eye Disease than is antithyroid drug therapy. This worsening can be temporary however, and may in some cases be prevented by use of the steroid prednisone.