▲Radiation can be used to assist the treatment of thyroid eye disease, remind the public to pay attention to their eye abnormalities, and seek medical treatment as soon as possible.

(Photo provided / Lin Yien)

Text / Lin Yien

Mr. Hong is a patient with long-term drug control of hyperthyroidism. In the past 3 months, he was referred from the ophthalmology clinic to the hospital for treatment because of diplopia and increased intraocular pressure when looking up and down.

Mr. Hong's ocular computed tomography showed hypertrophy of the superior lateral rectus muscle of the right eye, which indirectly led to secondary exophthalmos on the right side, and was diagnosed as thyroid eye disease.

After receiving 2 times of steroid pulse therapy, Mr. Hong went to the Radiation Oncology Department to receive a total of 10 times of radiation therapy in 2 weeks, which successfully improved his symptoms; 2 months later, he underwent strabismus correction surgery and is currently being followed up in the ophthalmology clinic. .

Please read on...

Symptoms of thyroid eye disease, or Graves' ophthalmopathy, include retracted eyelids, protruding eyes, dry eyes, red eyes, double vision, and limited eye movement.

About 50% of patients with hyperthyroidism will have eye lesions, and the incidence rate of women is higher than that of men.

The current pathogenic mechanism is believed to be that autoimmune antibodies mistakenly attack the orbital and posterior tissues, resulting in infiltration of inflammatory cells. Inflammation and hypertrophy of extraocular muscles can lead to obstructed eye movement and protruding eyes. possibility of blindness.

The primary goal of treatment for thyroid eye disease is to control thyroid function. If the patient smokes, the patient will be asked to quit smoking; if the patient's symptoms are not serious, local treatment (including the use of artificial tears, eye ointment, sunglasses, and ointment) can be given.

For moderate-to-severe patients without risk of blindness, the first-line drug treatment is mainly steroids, or use monoclonal antibodies, immunosuppressants, and radiation therapy; part of the bone to decompress and avoid permanent vision damage.

As for orbital radiation therapy, it is used for moderate to severe lesions, especially for patients with diplopia or limited eye movement. The purpose is to regulate the inflammatory response of the irradiated tissue, reduce the use of steroids, and avoid emergency eye pressure reduction surgery. Usually, the radiation therapy course is over. Afterwards, the patient is arranged to receive ophthalmic corrective treatment in the non-active period.

If people feel that their eyes are protruding or even have double vision, they should see a doctor as soon as possible to confirm whether there is a thyroid problem causing eye diseases, and receive relevant treatment according to the doctor's evaluation, so as not to miss the opportunity for treatment.

(The author is an attending physician in the Department of Radiation Oncology, Changhua Christian Hospital)

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keywords

  • blindness

  • Hyperthyroidism

  • Protruding eyes

  • Increased intraocular pressure

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