If you are diagnosed with exophthalmos, your ophthalmologist (eye specialist) will want to examine your eyes regularly. This is because, in some people, exophthalmos can get worse and the functioning of your eyes needs to be monitored.
If you have exophthalmos, the treatment your ophthalmologist recommends will depend on what is causing your symptoms.
If your exophthalmos is caused by a thyroid problem, treatment to improve the functioning of your thyroid gland may be recommended. The aim of this type of treatment will be to return your thyroid hormone levels to normal.
For example, an overactive thyroid can be treated with thionamides, a type of medication that prevents your thyroid gland producing excess amounts of thyroid hormones. See the Health A-Z topic about Overactive thyroid - treatment for more information.
Radioiodine treatment is another type of treatment for an overactive thyroid. It involves swallowing a chemical called radioactive iodine, which builds up in your thyroid gland and shrinks it.
Thyroid eye disease can sometimes get worse after radioiodine treatment. If radioiodine treatment is planned and you have thyroid eye disease, a careful assessment by an expert ophthalmologist or endocrinologist (a specialist in hormone conditions) is required before going ahead.
Treating your thyroid problems will not necessarily improve your eye symptoms. However, an untreated overactive thyroid or an untreated underactive thyroid can make the eyes worse.
In general, the longer you have had exophthalmos and the more severe it is, the more likely it is to be permanent. It is important to seek medical advice as soon as you notice exophthalmos so treatment can be started immediately.
Some other treatments that can be used to treat the eye symptoms of thyroid conditions include:
- raising the head of your bed, for example by using extra pillows, to reduce some of the puffiness around your eyes
- stopping smoking, as smoking significantly increases the risk of your thyroid condition affecting your eyes (see below)
- wearing sunglasses if you have photophobia (sensitivity to light)
- using eye drops to moisten your eyes if you have dry eyes
- wearing a patch over one eye if you have double vision
- selenium supplements, which may help people with mild thyroid eye disease that has recently started (selenium is a mineral found in brazil nuts, meat and fish)
The risk of developing thyroid eye disease is eight times higher in people who smoke than in people who do not smoke or who have quit smoking. The response of people who smoke to treatment for thyroid eye disease is also worse than for people who do not smoke, although this seems to reverse very quickly once you stop smoking.
If you smoke, you are also less likely to have your overactive thyroid cured after a course of treatment with thionamide medicine than people who do not smoke.
Corticosteroids may be recommended to treat severe cases of thyroid eye disease where the eyes are particularly painful and inflamed. Corticosteroids are often used to reduce swelling and inflammation.
You may be prescribed a high dose of a type of corticosteroid called a glucocorticoid. This treatment is effective but can cause a number of side effects such as:
You may be given corticosteroids intravenously (directly into a vein in your arm) as this is thought to be safer and more effective than taking corticosteroid tablets.
See the Health A-Z topic about Corticosteroids for more information.
Radiotherapy is a type of treatment that uses controlled doses of high-energy radiation, usually X-rays, to destroy cells. Low doses of radiotherapy can be used on the eyes to reduce the swelling. This is called orbital radiotherapy.
Orbital radiotherapy may be considered first, or if corticosteroids alone have not been effective or if your condition is getting worse. It may be combined with corticosteroids.
A review of a number of studies found that orbital radiotherapy was effective in treating eye symptoms caused by Graves' disease, particularly when combined with corticosteroids.
Radiotherapy can cause some side effects, although these should be minimal if the treatment is carried out correctly. See the Health A-Z topic about Radiotherapy for more information.
In some cases of exophthalmos, surgery is a very effective treatment. It will depend on the underlying cause of your exophthalmos. For example, surgery may be required if you have exophthalmos that is caused by a problem with the connection between the arteries and veins in your eyes.
Surgery is the only treatment that can improve significant exophthalmos in people with thyroid eye disease.
If you have other eye symptoms, surgery may be an option if these symptoms appear to be permanent and are not getting any worse. For example:
- Double vision may be treated by operating on the muscles of your eyes to bring the eyes back into alignment.
- Surgery to your eyelids can move your lids so that you can completely close your eyes again.
Orbital decompression surgery
In severe cases of exophthalmos, such as where vision is affected, surgery may be required to remove the bony floors of your eye sockets (orbits). This procedure is known as orbital decompression surgery.
During orbital decompression surgery, a small amount of bone is removed from your eye sockets. Some of the fat surrounding the socket may also be removed. This allows any excess material that builds up, pushing your eyeballs forward, to move down into the space below. It also allows your eyes to sit further back in your head, so that they do not protrude forward as much.
Complications can occur following surgery, for example the operation may cause double vision or it may make existing double vision worse. Ask your surgeon to explain the benefits and risks of the procedure to you.
The most common reason for performing orbital decompression surgery is to improve the appearance of people with thyroid eye disease who are affected by exophthalmos. Surgery may also be required when your vision is at risk. Centres with experience in this type of surgery have excellent results.
Treating a tumour
If you have a tumour behind your eye, your ophthalmologist will discuss the possibility of removing it with you. Depending on the type of tumour you have, possible treatment options include: