Thyroid ophthalmopathy

"Treatment of patients with thyroid ophthalmopathy requires restoring and stabilizing thyroid function, as these patients are more likely to have severe disease".


What is thyroid ophthalmopathy?

The eye involvement in hyperthyroidism is called thyroid ophthalmopathy and is an autoimmune disease where the body generates antibodies that react to the orbital fat and muscles of the eye, causing edema and inflammation.

In most cases it behaves like a disease with a single inflammatory outbreak (active phase) that can last months or even several years if not treated properly.

The outbreak is followed by a phase of inactivity and chronic sequelae produced by the inflammation.

What are the symptoms of thyroid ophthalmopathy?

The ocular affectation in hyperthyroidism ranges from small abnormalities, detectable only with specialized imaging techniques, to striking disfigurements.

Sensation of having grit in the eye, tearing, discomfort in the eye when looking at the light, redness, swelling of the eyelids, which can lead to intense pain and loss of vision.

It is frequent that there is protrusion or exit towards outside of the eyeball, giving the impression of "bulging eyes", so that sometimes the sclera, that is to say the white of the eyes, can be seen under the upper eyelid or above the lower eyelid.

The upper eyelids tend to swell and there are patients who have double vision.

The most common symptoms of thyroid ophthalmopathy are:

  • Tearing
  • Eyelid inflammation
  • Loss of vision
  • Double vision
  • Eyeball protrusion

Do you have any of these symptoms?

You may have a thyroid ophthalmopathy

What are the causes of thyroid ophthalmopathy?

It is autoimmune and in its development several growth factors and lymphotoxins are involved that lead to the cells called fibroblasts to produce in excess some substances - glycosaminoglycans - that accumulate in the muscles adjacent to the eye and in the fat behind it.

Glycosaminoglycans have a great capacity to retain water, producing the edematization or increase in size of these eye muscles and the tissue inside the orbit.

Since the orbit is bony, it cannot expand, so it cannot accommodate the enlarged eye structures, which conditions the eye to protrude outward, which is called eyeball proptosis.

The exposure of the cornea to external agents irritates it and hinders the venous return, causing a congestion, that is to say that the eye becomes red.

How is the diagnosis?

For the diagnosis of eye involvement in hyperthyroidism should be made:

  • Corneal affectation check, keratitis.
  • Carrying out a CT scan or MRI of the orbit to find out the degree of increase in extraocular muscles and retroorbital fat.
  • Evaluation of the affectation of the optic nerve, because although it occurs in less than 5% of patients with this disease, it is potentially very serious, since it can lead to a significant decrease in vision or its loss.
  • Depending on the degree of affectation, it is prudent to study visual acuity, visual fields and color vision.

How is thyroid ophthalmopathy treated?

Thyroid function must be restored to solve the cause of the ophthalmopathy

Medical treatment includes steroids, immunosuppressants or a combination of both.

Treatment with radiotherapy has an anti-inflammatory effect. It is carried out when medical treatments have not been sufficiently effective.

Surgical treatment is performed when the disease is in a phase of inflammatory inactivity. Patients may require different types of surgical interventions.

When there is a serious commitment to visual acuity by affecting the optic nerve, or a major exophthalmos, it may be necessary to decompress the orbit to expand its capacity.

There are a number of general measures that can help minimize symptoms and improve the patient's quality of life:

  • Instillation of artificial tears several times a day.
  • Use of sunglasses whenever going outdoors.
  • Sleeping with the head of the bed elevated about 10 or 15 centimeters to reduce eye exposure to external agents.

Where do we treat it?


The Thyroid Pathology Area
of the Clínica Universidad de Navarra

The Thyroid Pathology Area is made up of a multidisciplinary team of specialists who work together to offer patients with thyroid problems an accurate diagnosis.

After the diagnosis, the patient is indicated the most appropriate treatment for his or her case and a continuous follow-up is carried out to achieve the desired objectives.

The Clinic is a pioneer in the implementation of medical techniques in Spain and worldwide, and is an international reference in highly specialized procedures.

Imagen de la fachada de consultas de la sede en Pamplona de la Clínica Universidad de Navarra

Why at the Clinica?

  • Prestigious professionals who are a national reference.
  • In 24-48 hours we make the diagnosis and we can start the most appropriate treatment for each patient.

Nuestro equipo de profesionales

Specialists in thyroid problems with expertise in the treatment of thyroid ophthalmopathy