4/2007New trends in treatment of thyroid associated ophthalmopathy

MAGDALENA KOLENDA-PARAKIEL (Chair and Department of Pathophysiology, Wroclaw Medical University;Kierownik: dr hab. Witold Pilecki )

Summary
This paper reviews current knowledge about clinical findings and treatment of thyroid eye disease (TAO). TAO is a noninfectious, autoimmune disorder associated with inflammatory changes within the orbit, mostly connected with hyperthyroidism. Clinical signs and symptoms may vary and depend on the stage of the disease: from mild ocular discomfort with foreign body sensation or dry eye to intense pain, proptosis, extraocular muscle dysfunction, periorbital edema and may result in vision-threatening exposure keratopathy, troublesome diplopia, and compressive optic neuropathy. Thyroid eye disease is usually a self-limiting process and generally requires only supportive care. It is important to correct thyroid function abnormalities as this may aid in improving the ophthalmopathy. Severe orbital inflammation and congestion may require urgent intervention secondary to compressive optic neuropathy or excessive proptosis with corneal decompensation. Corticosteroids and radiation help decrease orbital inflammation and improve congestion. Orbital decompression surgery helps to expand the orbital tissue volume by removing bone from one or more orbital walls. Eye muscle surgery may be necessary to correct extraocular muscle dysfunction and double vision. Eyelid surgery may be necessary to correct eyelid retraction. Surgery usually is performed during the quiescent cicatricial phase of the disease, usually in the following order: orbital decompression, strabismus surgery, lid-lengthening surgery and blepharoplasty, if needed.

Key words: thyroid-associated ophthalmopathy, Graves’ ophthalmopathy, Basedow ophthalmopathy, thyrotoxic ophthalmopathy, endocrine ophthalmopathy