World-class treatment for thyroid eye disease

Posted on 16 March 2017

We look at the world-class treatment options available in South Africa for thyroid eye disease.

Thyroid eye disease (TED) is where the eye muscles and fatty tissue behind the eye become inflamed, usually arising from a thyroid problem called Graves’ disease. This may eventually result in the eye being pushed out of the socket, making it difficult to wear glasses or interact socially because of the disfiguration and can result in a high level of discomfort, such as chronic dry eyes. It can eventually lead to vision loss in severe cases if the optic nerve is damaged from the constant pressure.

Latest treatments for thyroid eye disease

Now a new surgical technique pioneered in South Africa called transorbital endoscopic decompression offers an exciting and potentially less invasive treatment option, using a GPS-guided camera. Here the surgery is performed via the mucous membrane that covers the front of eye from the inside of the eye socket and towards the sinuses.*

‘Decompression basically entails creating additional space into the sinuses that surround the eye socket, to make space for the enlarged muscles and increased fatty tissue,’ says Dr Petrus Gous, Pretoria Eye Institute ophthalmologist and oculoplastic surgeon.

Less scarring and faster recoveries

‘Orbital decompression surgery has come a long way since the early years of invasive procedures and is currently safer and less invasive. The trend has been towards minimally invasive decompression surgery in general, and orbital surgeons use small cuts around the eye that often won’t even require stitches and access the eye through the eye socket rather than by making incisions in the skin,’ he says. ‘This leaves no visible scarring on the skin around the socket, yet allows suitable access for decompression. An added benefit is shorter surgical times and faster recoveries,’ adds Dr Gous.

Graves’ disease and TED

‘Graves’ disease, the most common cause of TED, is an autoimmune disease that causes altered function of the thyroid gland (usually resulting in an overactive thyroid). It can result in inflammation and infiltration of the eye tissues with complications in some patients,’ says Dr Gous.

More severe TED cases have four main mechanical orbit problems that may require surgical corrections, namely:

• Bulging eyes with various degrees of eye exposure, and also the possibility that the optic nerve might be damaged owing to the enlarged eye muscles exerting pressure on the optic nerve.
• Strabismus or squinting leading to double vision due to enlarged eye muscles.
• Lid abnormalities such as upper or lower lid retraction (pulling in), due to tightening and scarring of some of the muscles surrounding the lid.
• Orbital fat prolapse or displacement with stretched and excessive upper and lower lid skin.

Non-surgical treatments

Non-surgical TED treatment includes medical management of the patient’s systemic hormonal over or under-function of Graves’ disease (which might include thyroid hormone replacement therapy, radioactive Iodine treatment or medication to suppress any residual thyroid function).

‘The need for surgical intervention depends on the degree of TED which is often more severe in smokers,’ says Dr Gous. ‘The bulging of the eyes from the sockets causes various mechanical and exposure problems, and symptoms such as painful and dry eyes are managed symptomatically with lubricants and other medications.’

In the acute inflammatory phase of TED, we sometimes use systemic steroids to treat the swelling until surgery. Systemic steroids have many potentially serious side effects, and should not be used long term, where they may become less effective in any case.

Further surgery

‘If a patient still has double vision after a successful decompression, we may operate on the eye muscles as well, although using prisms in their glasses are sometimes a temporary option. Then further surgery may be required for the lid retractions,’ he explains.

‘The eye muscle surgery is usually performed before any eyelid corrective surgery because this may already improve the lid retractions. Rarely, surgeons may also need to remove excess upper or lower lid skin and residual fat in the eye socket,’ says Dr Gous.

Make an appointment with an ophthalmologist if you suspect you may need eye surgery. Orbital decompression surgeries are available across South Africa.

*An interdisciplinary team of surgeons at Mediclinic Cape Town is currently offering transorbital endoscopic decompressions through Professor Darlene Lubbe’s practice.