Thyroid associated orbitopathy
Causes and risk factors
- In childhood, it is rare.
- In women it occurs more often (from 2.5 to 6 times) than in men.
- More common between the ages of 30 and 50.
- Closely related to cigarette smoking.
- The most severe manifestations increase with age, especially in men.
- The annual incidence in the United States is 16 women against 2.9 men per 100,000 people a year.
- Radioiodine therapy can worsen the picture or provoke it.
Which are the symptoms?
Orbital lesions can be mono- or bilateral and of varying severity. TAO usually occurs after the onset of thyroid dysfunction (usually hyperthyroidism), but can also precede it.
- retraction of the upper eyelid (a more open eye and a "barred" look);
- chemosis (ocular conjunctival edema);
- conjunctival hyperemia (redness of the conjunctiva);
- epiphora (tears running down the cheeks due to narrowing of the lacrimal ducts);
- periorbital edema (swelling of the tissues around the eye);
- diplopia (double vision);
- exophthalmus (protrusion of the eye).
How is it diagnosed?
How is it treated?
Diagnosis and treatment of TAO requires close cooperation between an endocrinologist and a neuro-ophthalmologist. Early assessment is very important to identify forms that are at risk of evolving and that can be helped by currently available therapies.
The behavioral norms that should be adhered to are as follows:
- strict following of the endocrinologist's instructions concerning the treatment of thyroid dysfunction;
- complete abstinence from smoking;
- avoiding smoky, dusty, and very dry rooms;
- regular use of artificial tears;
- protection of the eye from sunrays with appropriate eyewear;
- if necessary, use of masks while sleeping to help close the eyelids and avoid trauma to the cornea.
There are several treatment options, which must be chosen individually for each case. These include:
- correction of thyroid dysfunction, if any;
- immunosuppressive therapy (cortisone and other drugs);
- therapy with somatostatin analogues (octreotide, lanreotide);
- botulinus toxin injection (to treat retracted eyelids);
- orbit radiotherapy;
- surgical treatment (eyelid retraction correction, orbital decompression, strabismus correction).