Thyroid eye disease

Question 1

What is thyroid eye disease

Answer 1

autoimmune condition that affects eyes of people with thyroid dysfunction

Question 2

How can thyroid eye disease be prevented

Answer 2

smoking - most important modifiable risk factor

prednisolone may help to reduce the risk

Question 3

How may someone with thyroid eye disease present

Answer 3

can be eu/hypo/hyper thyroid at time of presentation

exophthalmos

conjunctival oedema

optic disc swelling

ophthalmoplegia

can have sore dry eyes

Question 4

What is the first line investigation

Answer 4

clinical assessment by an ophthalmologist

Question 5

What other investigations can be carried out

Answer 5

blood tests measuring thyroid functions, antibodies and inflammatory markers

imaging studies - assess degree of eye muscle and fat involvement

Question 6

What is the management for thyroid eye disease

Answer 6

Lubricating eye drops

can be offered oral glucocorticoids for severe symptoms

if above not effective can be offered orbital radiotherapy or Immunosuppressive therapy

Question 7

When may surgery be considered

Answer 7

severe cases where vision is affected or there’s significant disfigurement

Question 8

What symptoms/signs should indicate that a patient with thyroid eye disease needs an urgent review by an ophthalmologist

Answer 8

unexplained deterioration in vision

awareness of change in intensity/quality of colour vision in one or both eyes

history of eye suddenly ‘popping out’

obvious corneal opacity

cornea still visible when eyelids are closed

disc swelling