Non-Surgical Treatment for Thyroid Eye Disease

Introduction

One of the most prevalent results is eyelid retraction, which commonly needs care since it exposes the eyes and impairs cosmesis. The most successful course of action is still surgery. Still, there is a place for temporary adjustments when the illness is actively progressing, and in people who are not good surgical candidates, the currently known non-surgical methods for treating TED eyelid malposition. Hyaluronic acid, Triamcinolone injections, and Botulinum toxin type A are non-surgical therapeutic alternatives. Special attention should be paid to dosage, technique, effectiveness, and impact duration. When surgical correction is impossible, non-surgical therapy options may be feasible.

What Is Thyroid Eye Disease (TED)?

Inflammation of the fatty tissue behind the eye and the eye muscles is a symptom of TED, an autoimmune illness. The eyeballs may bulge forward or get red and inflamed due to this inflammation (referred to as "staring" or bulging), or they may protrude forward. In certain people, the inflammation may affect the ocular muscles, displacing the eyes and producing double vision. In a few rare instances, TED can result in blindness due to pressure on the nerve in the back of the eye or ulcers that develop on the cornea, the front of the eye.

Because TED is an autoimmune condition, the body's immune system attacks the tissue, causing inflammation and scarring. Although uncommon, TED can develop in people with an underactive or regularly functioning thyroid gland. It is typically linked with an overactive thyroid gland brought on by Graves' illness. A thyroid issue diagnosis may occur before, during, or after the development of TED in about 25 percent of Graves' disease patients. Graves orbitopathy (GO) and Graves's eye disease (GED) are further names for TED.

What Are the Symptoms of Thyroid Eye Disease?

The following are the most typical TED signs and symptoms:

• Bags under the eyes.

• Eyesight that is hazy or double.

• Eyes that look different (often bulging or gazing).

• Difficulty in shifting the eyes.

• Eyes that are either dry or watery.

• Gritty sensation in the eyes.

• Low tolerance for bright lights.

• Especially when looking up, down, or sideways, with eye pain or discomfort behind the eye.

• Redness of the eyelids and eyes.

• One or both upper eyelids are swollen or puffy.

What Are the Non-Surgical Treatment Options for Thyroid Eye Disease?

They may progress in the first six to twelve months after TED symptoms initially appear. Therefore, getting diagnosed and treated right away is crucial to stopping the problem from worsening. Artificial tear drops can relieve dry eyes in moderate cases of TED. Supplemental selenium is also advantageous. Steroids or orbital irradiation may be recommended for severe TED. Surgery could be advised for TED patients with persistent double vision or changes to the look of their eyes.

Approximately 75 percent of TED patients have mild to moderate illnesses and largely need supportive therapy for symptom control. The cornerstone of mild to moderate illness treatment is ocular lubrication, which can be achieved using daily eyedrops and nightly ophthalmic ointment. According to research, the symptoms of ocular surface irritation can be improved by topical Cyclosporine.

In addition to eye lubrication, the following lifestyle changes are beneficial:

• Giving up smoking.

• Restricting sodium helps to prevent tissue edema and water retention.

• Sleeping with the head of the bed raised to reduce orbital edema.

• Sunglasses to lessen phobic sensations and a feeling of dryness.

• If periocular discomfort is a common complaint, oral NSAIDs may be prescribed.

• Temporary press-on prism lenses, such as Fresnel, can be used when diplopia is present.

1. Corticosteroid Therapy

The mainstay of TED therapy is corticosteroids. The anti-inflammatory and immunosuppressive properties of corticosteroids are what give them their beneficial benefits.

• Usually, this is begun at high dosages (60-100 mg per day).

• Most successful in treating visual neuropathy and soft tissue alterations.

• Usually gradually tapered over several months.

2.Intravenous Corticosteroid

• IV treatment is often more successful (mean efficacy is 70 percent ) and more tolerated than oral delivery.

• IV therapy typically lasts 12 weeks (6 weeks at 500 mg once weekly; six weeks at 250 mg once weekly), as opposed to months of oral prednisone therapy. This enables the simple and quick identification of "non-responders."

• IV lessens the need for further medical treatment.

3. Orbital Radiation Therapy

Since over a century ago, orbital radiation (ORT), which can be used alone or in combination with corticosteroids, has been utilized to treat thyroid eye disease.

Mechanism of Action

• The temporary sterilization of lymphocytes.

• It is possible to promote terminal differentiation in ocular fibroblasts.

• There is little adipocyte differentiation or fatty hypertrophy.

• Patients under 40 with greater ocular fat hypertrophy benefit more from this treatment.

• Tissue-bound monocytes are killed by radiation.

• About 60 percent of patients have reduced inflammation of the ocular surface and eyelids due to radiation blunting the immune response at the orbit.

• Proptosis and eyelid retraction have not been demonstrated to be significantly affected by ocular radiation therapy.

• Radiation reduces ocular surface and eyelid inflammation in around 60 percent of patients by dampening the immune response at the orbit.

Thyroid eye disease side effects that can be addressed with orbital radiation therapy include the following:

• Vision-related compression neuropathy.

• The periorbital and ocular regions are inflamed.

• A blockage in the orbit.

• Strabismus and poor ocular motility.

Treatment plan and results

• Utilize 2000 cGy spread out over 10 therapy sessions over two weeks.

• The peak impact happens about six months after the last treatment.

• Conjunctival injection, chemosis, and periorbital edema all temporarily worsen with treatment.

Conclusion

Mental and social health may be impacted by thyroid eye disease. If thyroid hormone levels change, the patient can feel anxious, irritable, or moody. Maintaining overall health and well-being, reaching a euthyroid state (without post-treatment hypothyroidism), and encouraging smoking cessation are all management objectives. The active illness's duration is shortened by quitting smoking and treating euthyroidism. As well as avoiding exposure keratopathy, treating diplopia, and enhancing blink dynamics and cosmesis, the main objective is maintaining visual function.