Thyroid Ophthalmopathy (Goiter-Related Eye Dislocation) (Graves' Orbitopathy)

Thyroid disease (goiter) is common in Turkey due to the current iodine deficiency. For this reason, the most common additional finding of thyroid disease is the eye. Eye involvement due to goiter, which can lead to eye dislocation, double vision and blindness, is defined as thyroidophthalmopathy (Gravesoftalmopathy). Eye involvement may occur due to frequent overactivity of the thyroid gland (toxic goiter), less rarely due to underactivity of the thyroid gland (hypothyroidism), or Hashimoto’s thyroiditis. Ocular findings may include drooping of the upper eyelid, eye dislocation (exophthalmos), diplopia, optic nerve involvement, and blindness. Dry eye and corneal melting can be observed due to the inability to close the eye during the night and later during the day due to the dislocation of the eye. In this picture of the eye, the cause is edema in the orbit (eye socket) behind the eye, swelling in the muscles that move the eye, and crushing of the optic nerve. This disease may occur after symptoms such as weight loss, tremor in the hands, irritability caused by the dysfunction of the thyroid gland, or eye symptoms may occur before the thyroid disease.

It can be understood that many patients have thyroid disease by the dislocation of their eyes. In this disease, redness of the eyes, eyelid swelling and eyelid edema are observed in the early period, while eye dislocation and vision loss may develop in the later period. Blindness may occur in the future. In these cases, early treatment may prevent the eye from protruding. Correction of thyroid tests, smoking cessation and simple eye drops are recommended in the early period, while cortisone treatment may be required in severe cases. This treatment is an intravenous protocol. If protrusion of the eye cannot be prevented in the late period, orbitadecompression is applied to reposition the eye. Cortisone given in the late period is useless and unnecessary to put the eye in place, and it has no benefit other than the side effects of cortisone. When to apply cortisone drug therapy and when to perform surgical decompression should be decided by the examination of an experienced oculoplastic surgeon. Orbitadecompression is a surgery performed under general anesthesia. It is a surgery that involves removing the bone structures around the eye and removing the increased fat tissue in the orbit.

Dr. The 3 most frequently asked questions to Onur Konuk about eye dislocation treatment and orbitadecompression in thyroid ophthalmopathy:

1. I have thyroid-related eye dislocation in my eyes. Is it possible to restore my eyes?

Thyroid-related findings in your eyes may include eyelid opening, eye dislocation, double vision, and decreased vision. Each of these is a table holding different textures in the eye, which should be dealt with individually. For example, the opening of the eyelid suggests eyelid involvement, the protrusion of the eye suggests orbital edema, and double vision suggests thickening of the muscles that move the eye. It is possible to correct these in steps with medication or surgery. However, there is an order and a time for this. A single treatment should not be expected to correct all findings. First of all, an experienced oculoplastic surgeon should decide which tissues are affected by the findings and start treatment accordingly.

2. Goiter-related dislocation developed in my eyes, my doctor recommended cortisone treatment. What path should I follow?

Cortisone treatment will not fix the protrusion in your eyes. Cortisone therapy is used to regress eyelid orbital edema in early ocular findings. However, it has been shown that cortisone treatment does not improve the dislocation of the eye. Orbitadecompression surgery is required in the treatment of this.

3. How many days will orbital decompression surgery keep me from work?

Decompression surgery is one of the most difficult operations on the eye, which takes a long time. Today, simultaneous surgery is performed on both eyes in order to reduce the postoperative symmetry of both eyes and to reduce anesthesia-related complications. Eyes can be operated at different times, depending on individual preferences. Average hospital stay is 3 days. If it is planned that the swelling and stitches in the eye will be removed after 15 days, the patient will rest at home for approximately 20 days.