Thyroid eye disease frequently asked questions

Thyroid eye disease frequently occurs bilaterally, but can occur in only one eye. However, bilateral affectation may be asymmetric, in the sense that one eye is more affected than the other. 

It usually appears later in men and can be more aggressive. 

Spontaneous remission of the disease takes place over a maximum of 18 months. However, cases of reactivation after a period of inactivity have been described. This occurs in 5-15% of cases and is associated with factors such as periocular surgery, high levels of stress, poor control of hyperthyroidism and smoking. 

Yes, patients can also develop thyroid eye disease in the absence of hyperthyroidism, with normal thyroid function. 

No relationship has been shown between thyroid eye disease and glaucoma, although an increase in intraocular pressure may occur in some patients. 

In thyroid eye disease, strabismus is caused by an affectation of the extraocular muscles, either by the inflamed phase or the fibrous tissue that is left after inflammation. One or several extraocular muscles may be affected in this process. Asymmetric bilateral eye disease (one eye more affected than the other) is characteristic of this. Characteristic symptoms are: vertical strabismus, limitation of superior gaze due to involvement of the inferior rectus muscle, esotropia (deviation of the eyeball towards the nasal region) and limitation of lateral gaze due to fibrosis of the medial rectus muscles. 

Optic neuropathy is the most serious complication since it can cause irreversible vision loss. 

Eyelid retraction (more open than normal) is undoubtedly the most frequent and characteristic manifestation of the disease. The patient perceives that his eye is more open, so ocular discomfort such as dry eyes may appear. 

All patients, regardless of the degree of activity and severity of the disease, can benefit from topical treatment with eye drops, which may be of higher viscosity depending on the symptoms. Eye drops, gels or ointments can be used; even night eye patches, if necessary. 

Before being treated with radioactive iodine, it is very important to have an initial ophthalmological evaluation, to rule out active orbital inflammation. The use of corticosteroids together with the treatment is also recommended, to prevent the disease.