Thyroid Eye Disease : more to it than meets the Eye

Authored by : Dr Saptagirish 

HoD Orbit and Oculoplastics, Dean, Sankara Eye Hospital, Bangalore 

Thyroid Eye Disease (TED) is mostly caused by the immune system targeting the muscles and tissues that surround the eyes, which causes irritation and an array of ocular symptoms. In a study conducted over 18 months in 2020, it was found that 34.7% patients with thyroid dysfunction having TED and 4:1 ratio of women to men with TED. With the advancement of AI and technology, it is much easier to diagnose TED and provide much more advanced treatment that will help in the speedy recovery of the patient.  People need to be conscious of these indications and get help as soon as possible to prevent them from getting worse. Failure to do so may lead to complications, including potential vision loss.

Key Clinical Features of Thyroid Eye Disease:

Protrusion of Eyes (Proptosis): One prominent indication entails the protrusion or bulging outwards of one or both eyes due to swelling and inflammation affecting the eye muscles along with adjacent tissues.

Double vision: TED can induce restriction of one or more muscles that help rotate the eyes in different directions, thereby leading to double vision medically termed diplopia.

Ocular Discomfort and Pain: Individuals afflicted with TED often experience discomfort accompanied by dull aching pain within their affected eyes coupled with sensations akin to grittiness, irritation and foreign body sensation.

Swelling and Inflammation: Swelling alongside inflammation in tissues surrounding the eyeballs leads to redness, pain and discomfort

Dry eyes: Reduced production of tears, inability to close eye completely and increased visualization of white part of the eye leads to dryness

Cosmetic disfiguration: bulging of one or both eyes, staring look, inability to close eyes completely and eyelid lag can result in unsightly appearance aesthetically displeasing to some individuals.

Systemic manifestations: Weight loss, palpitations, increased heart rate, heat intolerance and generalised apprehension and anxiety should alert one on presence of hyperactive thyroid hormones. Ocular manifestations may precede or follow systemic manifestations in a majority of individuals.

Dietary Considerations

When managing TED closely paying heed towards eating habits emerges as beneficial thus certain considerations worth pondering include:

Foods that should be avoided include processed foods, as they often contain high levels of sodium which can contribute to water retention and worsen eye swelling. Excessive intake of sugary foods should be restricted as it may lead to inflammation in the body. It is always recommended to follow a low-sugar diet to help manage symptoms.

Selenium supplements: Dietary sources like onions, garlic, meat, seafood, shellfish, eggs and cereals or selenium supplements prescribed by a medical practitioner have beneficial effects in controlling symptoms and progression in mild TED due to its antioxidant properties.

Addictions: Smoking and alcohol are substances that have the potential to exacerbate eye discomfort and disrupt sleep patterns associated with Thyroid Eye Disease (TED). Therefore, it is advisable to gradually reduce and stop consumption of these substances altogether.

To take precautions against TED, regular medical check-ups are essential. By scheduling routine appointments with healthcare providers, individuals can monitor their thyroid function and assess the progression of TED more effectively.

Lubricants: The use of lubricating eye drops can also alleviate dryness and increase overall comfort experienced by some individuals.

Adequate sleep plays a significant role in promoting overall well-being while alleviating uncomfortable symptoms such as eye discomfort. It's important to prioritize quality rest by ensuring sufficient hours of uninterrupted sleep each night.

Furthermore, stress management techniques prove beneficial for managing autoimmune conditions related to TED. Adopting practices like meditation or yoga helps individuals cope better with stressors that could potentially worsen their condition over time.

Understanding Thyroid Eye Disease requires awareness of its symptoms alongside implementing supportive dietary choices and taking the necessary precautions mentioned above. This includes seeking personalized advice from healthcare professionals regarding tailored treatment plans. Finding a balance between medical guidance, and lifestyle modifications allows people affected by this condition, to improve their overall well-being effectively, and successfully manage its impact on ocular health.

•         Indian Journal of Ophthalmology: Clinical profile of thyroid eye disease and factors predictive of disease severity

•         National Library of Medicine: Selenium supplementation in thyroid associated ophthalmopathy, an update