What is the treatment for thyroid eye disease?

In patients with mild involvement, irritation and foreign body sensation may improve with artificial tears and the use of lubricating ointment at night. If the lids are not closing completely, they may be taped closed at night. With more severe corneal problems, lid surgery to help partially close the lids or to raise the lower lids may be necessary. In severe retraction of the upper or lower lid, surgery to reduce the effects of the lid retractors, either without or with spacer placement (such as a piece of tissue removed from the roof of the mouth) can help the lids to close. Smoking may worsen symptoms and should be discontinued.

There is no medicine that improves the ability of muscles to move (and thus relieves double vision). Covering one eye immediately relieves double vision. It may be possible to optically realign eyes with the use of prisms either applied to glasses or ground into the lens although this may not be effective until things stabilize. When double vision cannot be corrected with prisms, eye muscle surgery may be necessary. Often multiple muscle operations are necessary. It is sometimes not possible to completely remove double vision, but the goal is to remove double vision looking straight ahead and in reading position, as these are the most important directions of sight.

Fortunately, optic nerve problems resulting in decreased vision are uncommon. When it occurs, treatment is aimed at shrinking the muscles, usually by the use of high dose steroids (prednisone). For those patients who will not tolerate steroids radiation therapy may be of benefit. If the muscles cannot be made small enough to relieve the compression of the optic nerve (resulting in decreased visual acuity) then the orbit can be made larger. This is usually done surgically by removing one or more of the bony walls of the orbit. Since the optic nerve is usually compressed at the very back of the orbit, removing the posterior medial wall of the orbit is most critical. This may be done directly (through the soft tissues or skin around the eye), through the sinus under the eye, or through the nose. To further reduce the eye bulge the floor, lateral wall, or even the roof of the orbit may be removed. One of the problems with surgical decompression is that this often affects eye movements, thus changing the pattern of double vision (if it already exists) or potentially producing double vision in those patients who don’t have it before surgery.