Endocrine orbitopathy is an inflammation caused by immunology. It mainly affects the orbital contents, but also involves the eye muscles and eyelids. Treatment of the disease proves difficult.
What is endocrine orbitopathy?
Endocrine orbitopathy refers to inflammation of the orbital contents. It is immunologic and affects the tissues of the orbit as well as the eye muscles and eyelids. The disease usually occurs as a consequence of a hyperthyroid metabolic state and is thus a frequent concomitant disease of various autoimmune thyreopathies such as Graves’ disease. The name of the disease is composed of the terms “endocrine”, which means “hormonal” and “orbita” for eye socket. Thus, endocrine orbitopathy is a hormonally related disease of the eye sockets and surrounding tissues.
Causes
The causes of endocrine orbitopathy are found in Graves’ disease. About 85% of people who have Graves’ disease develop damage to the orbits during the course of the disease. The timing of this can be completely different. For example, endocrine orbitopathy may develop before Graves’ disease, but may not become apparent until years later. Even a complete cure of the triggering disease cannot always prevent an outbreak of the orbitopathy. Endocrine orbitopathy rarely occurs in the absence of identifiable thyroid disease. Thus, Graves’ disease is the main cause of the disease. However, in very rare cases, the so-called Hashimoto’s thyroiditis can also cause a hormonally induced orbital disease. Since Graves’ disease is usually the main cause, the causes of the onset of the immune disease can also be seen as the cause of endocrine orbitopathy. These are usually genetic predispositions, viral infections or stress. Excessive consumption of cigarettes can also promote Graves’ disease and, consequently, endocrine orbitopathy.
Symptoms, complaints, and signs
This disease leads to a number of different symptoms and complications. In most cases, it causes discomfort in the eyes. Patients suffer from protruding eyeballs. Because of this, there are also aesthetic complaints, so that the patients suffer from inferiority complexes or reduced self-esteem. Therefore, depression and various other psychological upsets may also occur. Likewise, patients suffer from enlargement of the thyroid gland and a goiter that can form directly on the neck. This can cause various malfunctions of the thyroid gland. This leads to heart palpitations and, in the worst case, to a heart attack, which can lead to death. Due to thyroid problems, many patients also suffer from underweight or overweight. There is severe swelling of the eyelids and various visual disturbances. The patient’s vision decreases and those affected suffer from double vision or veil vision. In general, the patient’s quality of life is significantly reduced by the disease. If treatment of the symptoms is not started at an early stage, the eye complaints may remain permanently. As the disease progresses, failure of the heart muscle may also occur.
Diagnosis and course
The ophthalmologist can make the diagnosis of endocrine orbitopathy on the basis of various examinations. In advance, he or she determines any symptoms that occur. If the patient states that he suffers from watery or burning eyes or sees double vision, these are about the first signs. Temporary or permanent blindness is also a clear symptom. After talking to the patient, the doctor determines the eye pressure and examines the mobility of the eye muscles. The visual field and eye muscles are also examined by ultrasound. Finally, the palpebral fissure width is determined and the characteristic protrusion of the eyes is examined. If there is a concrete suspicion after these examinations, the ophthalmologist may order an MRI examination to determine the extent of the endocrine orbitopathy. The results of this examination are used to assess which forms of therapy may be considered. The course of the disease depends largely on the time of diagnosis. If early action is taken, late effects can be avoided, whereas existing damage usually persists if treatment is delayed.
When should one go to the doctor?
If the eyelids swell for no apparent reason, a doctor should be consulted as soon as the symptoms persist for several days. If there is an increase in swelling, a doctor should be consulted immediately. Impaired vision increases the general risk of accidents. If there are changes in the visual image, there is reason for concern. If eye movements can no longer be coordinated as usual or if there is a perception of double images, this is considered particularly unusual. A visit to the doctor is necessary to initiate medical treatment and to obtain relief from the symptoms. If there are problems with the heart rhythm and palpitations, a doctor should be consulted. If the heart complaints persist over a longer period of time, the risk of heart muscle failure increases. This is a life-threatening condition that must be counteracted in time. If the eyeball protrudes in an unusual shape, a doctor should be consulted. If there is a visually perceptible enlargement of the thyroid gland, changes in the eye socket as well as the palpebral fissure and a simultaneous increase in the heart rate, a visit to the doctor is necessary. If anxiety or panic occur due to the symptoms, a doctor or a therapist should be asked for help and support. If there are changes in behavior, mood swings or emotional problems, a doctor is also needed.
Treatment and therapy
There are differing opinions among specialists about the best possible therapy for endocrine orbitopathy. However, there are some treatment options that are promising. First and foremost is always the elimination of Graves’ disease. For this purpose, the thyroid gland must be optimally adjusted with the help of various medications. If this is not possible or does not bring success, the thyroid gland or parts of it are surgically removed. This can at least alleviate endocrine orbitopathy in many cases. The chances of success depend primarily on how far the disease has progressed. Damage to vision can rarely be completely corrected. Another treatment option is radioiodine therapy. This is a therapy with iodine, which is rarely used. The reason for this is the risk of aggravating the endocrine orbitopathy or even triggering another disease. Only if the endocrine orbitopathy does not occur in connection with Graves’ disease, radioiodine therapy is recommended. If the chances of curing endocrine orbitopathy are too low, at least the symptoms can be alleviated. For this purpose, various agents such as cortisone and antioxidants are prescribed. Methotrexate is also used in low doses.
Outlook and prognosis
The prognosis of endocrine orbitopathy depends on the time of diagnosis and the start of medical care. If the inflammation is already very advanced and the patient has a weakened immune system, long-term therapy is usually initiated. If treatment is initiated early, there is a good chance of cure. Nevertheless, most patients experience permanent damage to the exophthalamus. This is accompanied by an optical stain and can cause psychological problems. Vision is not permanently affected. Patients who are smokers or who frequently spend time in areas containing nicotine often experience deterioration or a more difficult healing process. There may be delays in the recovery of symptoms. In addition, there is a possibility that further irreversible damage may develop. If the treatment plan includes the use of radioiodine therapy, it must be taken into account that this therapy leads to deterioration in a large number of patients. If other thyroid diseases are present in addition to endocrine orbitopathy, further delays or complications may occur. Thyroid values must be monitored at regular intervals and drug regimens must be adjusted. Particularly problematic are cases in which psychological sequelae have developed as a result of the symptoms. Treatment may take a long time.
Prevention
Endocrine orbitopathy cannot be directly prevented. However, the risk of disease can be reduced. Thus, it already helps to avoid stress as far as possible and to resort to various relaxation techniques.Autogenic training, for example, is one way to reduce stress. Giving up cigarettes is also a preventive measure. Smokers with a hereditary predisposition have a much higher risk of developing Graves’ disease and thus endocrine orbitopathy than non-smokers. Therefore, it is recommended to become a non-smoker or to continue to abstain from cigarettes. In addition, it is especially important to strengthen the immune system. Those who exercise a lot, eat a healthy diet, and increase their well-being can minimize the risk of contracting the disease.
Aftercare
The person affected by this disease usually has very few or even no measures or options for aftercare available to him, so that he is primarily dependent on early detection and subsequent treatment of the disease. There is also no possibility of self-healing, and at present there is also no effective and direct possibility of therapy. In most cases, those affected are also dependent on the help and support of friends and their own family, so that the symptoms do not continue to worsen. Sufferers themselves are often dependent on taking medication for this disease. If there are any questions or uncertainties about how to take the medication, a doctor should always be consulted first. It is also important to ensure that the correct dosage is taken and that the medication is taken regularly in order to counteract the symptoms. Furthermore, regular examinations and controls of the thyroid gland should be carried out, whereby this can be supported with the help of iodine. Contact with other sufferers of the disease can also be very useful, as this often leads to an exchange of information.
What you can do yourself
Patients affected by endocrine orbitopathy should not expose their eyes to unnecessary stress. Darkness or excessive exposure to light can be additionally stressful for vision. When reading or working at computer screens, care should also be taken to ensure good visibility. If contraction of the forehead muscles or tension of the eyes occurs, an optometrist should be consulted so that an option can be found to provide adequate relief. Cosmetic items such as eye shadow or mascara should not be applied. This puts a strain on the eyelids and can exacerbate discomfort in puffy eyes. Rubbing and scrubbing the eyes should be avoided as a matter of principle. This would increase the intensity of the irritability of the skin. The patient can apply soothing ointments or creams to relieve the eye area and alleviate the symptoms. Adequate sleep and regular rest also help to strengthen the sense of well-being. Smoking should be discontinued, and patients should refrain from spending time in premises where people smoke. For mental strengthening, patients can use relaxation techniques. These reduce everyday stress and promote inner stability. In addition, a healthy and balanced diet and sufficient physical activities help. These support the immune system, which is particularly stressed in the inflammatory disease.