Thyroid Eye Disease

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Thyroid Disease Treatment - for improved vision and facial appearance

Thyroid eye disease (TED) is an autoimmune condition that often occurs in people who develop an overactive thyroid gland. TED causes the fat and muscles behind the eye to enlarge. Symptoms include redness, irritation and pressure behind the eyes. This can push the eye forward and restrict its movement, resulting in the inability to fully close the eyelids. In some cases, protruding or misaligned eyes and double vision can occur.

Dr. Kimberly Cockerham has made the treatment of TED an integral part of her practice for over 20 years. She can effectively address the conditions caused by TED with medical management or by performing state-of-the-art eyelid, eye muscle or orbital surgery.

Kimberley Cockerham, MD, moderates this series of 6, paired conversations between endocrinologist Terry J. Smith, MD, and eye specialists Wendy W. Lee, MD, and Raymond Douglas, MD, PhD, to explore current and emerging treatment options for thyroid eye disease.

Learn More: Annenberg Center for Health Sciences

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Diagnosing And Treating Thyroid Eye Disease

Through state-of-the-art vision testing, Dr. Cockerham can diagnose your condition and recommend the most appropriate treatment based on your individual needs. Her treatment options include:

• Topical ointments, artificial tears (preservatives are bad – so stay away from that Visine®) and
• topical anti-inflammatory drops
• Topical, intranasal, oral, infusions behind the eye or intravenous corticosteroid treatment
• Orbital radiotherapy
• Removal of fat and sculpting of bone to restore the eye position (orbital decompression)
• Eyelid retraction repair surgery to allow the eyelids to close
• Eye muscle surgery to allow single vision
• Eyelid skin debulking, fat sculpting
• Skin resurfacing with topical products, peels and lasers

Dr. Cockerham is an international leader in thyroid eye disease research and has been active in the development of innovative minimally invasive therapeutic options. Dr. Cockerham looks forward to meeting you and helping you with your medical and aesthetic concerns.

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Management of TED

The most common medical interventions - corticosteroids and/or external beam radiation - are typically reserved for patients with a vision threatening active phase or rapidly progressive orbitopathy.

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Rationale for Using Corticosteroids for TED

• Oral corticosteroid treatment (usually Prednisone) has been associated with a short term decrease in soft tissue swelling, optic neuropathy and extraocular muscle size in up to 65% of cases
• The clinical response to intravenous corticosteroids is as high as 85% with fewer side effects than oral Prednisone

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Rationale for Using External Beam Radiation

Data addressing the efficacy of orbital irradiation, either alone or in combination with other treatment modalities (corticosteroids, steroid sparing agents, surgery) is conflicting. Overall improvement rates of 60-65% are typical in reported studies treating TED patients in the active phase of the disease. Radiation can decrease redness, swelling and discomfort; but is not routinely effective in reducing proptosis or double vision. Radiation can also be used effectively if optic neuropathy is present in an actively inflamed TED patient. Radiation is contraindicated in Diabetics.

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The Role of Surgery in Thyroid Eye Disease

In most cases, surgery is delayed and is targeted at modification of stable phase dysfunction. Orbital Decompression surgery is effective in decreasing or eliminating the bulging (proptotic) eyes.

Eyelid retraction repair surgery is effective in decreasing or eliminating the stare that is so characteristic of TED. The eyelids are often staying open at night and causing break down of the surface of the eye.

Eye muscle surgery is performed to restore single vision when looking straight ahead and down. Unfortunately, there is no way to return the muscle function to normal – so double vision in extremes of gaze is a common permanent change.

Although late surgical interventions can help decrease disfigurement and allow the patient to see a single image when looking straight ahead, the tissue alterations are irreversible. There is no way to restore normal eye muscle movement or pre-disease appearance. Thus, many of the manifestations of TED are permanent.