Thyroid associated opththalmopathy

Hyperthyroidism refers to a group of disorders characterized by over-production of thyroid hormone by the thyroid gland. Of these disorders, toxic diffuse goiter or Graves' disease is most frequently associated with ocular complications. Graves' disease is an auto-immune process that has a predilection for middle-aged women. Thyroid opththalmopathy may reflect increased sympathetic tone and/or an infiltrative immune mediated process. Lid retraction, proptosis, chemosis, injection and ocular discomfort are relatively benign signs of thyroid eye disease, but may cause significant emotional and functional disturbances. More advanced disease characterized by keratopathy, motility restriction, and optic nerve compression represent greater threats to ocular function and may require intensive therapy. Thyroid management, systemic steroids, local irradiation and surgery represent the cornerstones of management for thyroid associated ophthalmopathy. Ocular therapy should be used judiciously as the disease is associated with a good functional and cosmetic outcome for most individual. However, those with sight threatening diesease or severe cosmetic alterations should be treated agressively and, preferably, before fibrosis leads to permanent orbital abnormalities.(AU)