Thyroid-associated ophthalmopathy (also called graves ophthalmopathy) is an autoimmune disease, and its main clinical manifestations are eyelid edema, exophthalmos, eyelid retraction and increased ptosis. Most people have eye diseases a few months after finding thyroid dysfunction, even though some patients lack objective manifestations of thyroid dysfunction when suffering from eye diseases. If after careful evaluation, close follow-up and sensitive thyroid function examination, it is found that more than 90% of patients have abnormal thyroid function, then the incidence of thyroid-related eye diseases in women is six times that of men. Early symptoms include eye irritation, edema around eyes, eyelid retraction, eye movement disorder and diplopia, exophthalmos, exposed corneal ulcer and so on.

Clinically, with the improvement of hyperthyroidism symptoms after treatment, exophthalmos can be improved in some patients, and hyperthyroidism symptoms can be improved and exophthalmos can be aggravated in some patients after treatment. Generally speaking, it is the natural course of disease from onset to stable remission, which is generally 6 months to 3 years. Exophthalmos is the most serious within 4 ~ 12 months after onset, and the development trend stops on its own. 1 ~ 3 years later, half of the patients can subside, and the symptoms of soft tissue involvement can be alleviated or disappeared, but exophthalmos rarely returns to normal, leaving a certain degree of eyelid contraction and disappearance.

The problem that patients with thyroid-associated ophthalmopathy should pay attention to is to control and avoid the aggravation of the disease. Patients should pay attention to the following points:

Strictly quit smoking. A large number of studies show that smoking will obviously aggravate the condition of eye diseases.

The pillow is higher when sleeping. This can relieve the increase of orbital pressure caused by venous reflux obstruction and relieve eye symptoms.

Wear sunglasses when going out in strong sunlight to reduce irritation symptoms.

If the cornea is exposed during sleep, you should apply eye ointment before going to bed. This can prevent exposure keratitis.

therapeutic method

Because the cause of the disease is unknown, there are many treatment methods at present, but symptomatic treatment and reducing complications are the main ones. The course of thyroid-associated ophthalmopathy is generally divided into two stages, namely, active stage and static stage.

For active patients, the treatment methods include: local treatment. Pay attention to eye rest and wear sunglasses to avoid strong light and various external stimuli; If the eyes are not completely closed, apply antibacterial eye ointment and put on an eye mask before going to bed to protect the conjunctiva and cornea; Use unilateral eye patch to reduce diplopia, lie flat on the pillow, control salt intake, and alternately use antibacterial eye drops (ointment) and cortisone eye drops. Oral hormones such as prednisolone. Retrobulbar radiotherapy. When high-dose corticosteroids are ineffective or corticosteroids cannot be used, better curative effect can be obtained.

Patients with serious complications such as exposure keratitis and optic atrophy, or patients who are at rest and have obviously damaged appearance, may consider taking surgical treatment. The surgical method comprises the following steps:

Removal of orbital bone wall decompression and removal of orbital fat decompression can make eyeball retreat obviously and relieve orbital pressure.

For patients with excessive ptosis and obvious ptosis, levator palpebrae superioris lengthening can be used to improve their appearance.

If diplopia is serious, strabismus can be corrected after the condition is stable for half a year.