The treatment of thyroid-related ophthalmopathy is a very [personalized] process. As the clinical manifestations and severity of each person vary greatly, the treatment methods may also vary greatly.
Some patients only gradually found that the eyeball was a little prominent, or the eyelid was a little [elevated], which did not affect their eyesight or other discomfort. Some patients have obvious eyeball protrusion, pain and discomfort in a short period of time, and even acute vision loss. Although the treatment schemes for the two patients will be very different, there are still some similarities.
Medical treatment, control thyroid function normal and stable
Maintaining normal and stable thyroid function is the primary focus of treatment.
Please follow the advice of endocrinologists for treatment and regularly review thyroid function.
During the treatment of hyperthyroidism patients, they also need to be alert to drug-induced hypothyroidism. Studies have shown that this situation is also easy to cause eye diseases.
Stable thyroid function is the basis for the treatment of eye diseases. However, it should be emphasized that curing the thyroid does not necessarily mean that the eye diseases will definitely improve. However, if the thyroid cannot be cured, the chances of curing eye diseases will be even lower.
In addition, there are still a small number of patients with eye diseases whose thyroid function has not been found to be abnormal. If this is the case, then there is no need to struggle too much, just focus on ophthalmic treatment.
Ophthalmic treatment focuses on protecting the function of the eyeball.
For thyroid-related ophthalmopathy, doctors can divide the current state of patients into active phase and inactive phase according to a series of clinical standards.
The meaning of active phase is that the inflammation of orbital tissue of patients is now in active phase. Patients in inactive phase are relatively stable. Different periods, the emphasis of treatment is different.
1. Inactive phase: Protect cornea
Patients in the inactive phase are relatively stable and do not need active anti-inflammatory therapy. At this time, the focus of treatment is to protect the cornea.
This part of patients due to the formation of eyelid closure is not close, it is easy to because the cornea can not be protected by eyelid for a long time, forming exposure keratitis. If accompanied by continuous friction of inverted eyelashes, it will be even worse.
As soon as doctors find the presence of exposed keratitis, they will issue an important prescription: eye cream or eye gel must be applied before going to bed at night, and artificial tears can be used to assist during the day. Some patients also need to wear some special protective glasses.
If there is a little inverted eyelash, the doctor may pull it out for the time being and tell the patient that the inverted eyelash will grow out again and must be removed regularly.
If keratitis is still not relieved, or secondary corneal infection occurs, or there are too many inverted eyelashes, further surgical treatment may be required.
2. Active phase: Control orbital tissue inflammation and protect vision
For the treatment of patients in active phase, besides protecting cornea, it is more important to control inflammation.
Thyroid-associated ophthalmopathy is inflammatory edema of tissue in the orbit. These edematous tissues are like being placed in a too small bowl, which can only pour out continuously and squeeze out the eyeball.
If tissue edema does not decrease, the exophthalmos and optic nerve compression caused cannot be relieved, and vision may be permanently damaged.
The most commonly used and effective drug to control inflammation is glucocorticoid. According to different situations, there will be different methods of medication, mainly in two ways.
- Conventional hormone therapy, Start with a larger dose, Then slowly reduce the dosage, Until the drug is stopped. This process of taking medicine usually takes several months to half a year. Never stop taking medicine by yourself during this process. If the disease is repeated during the drug reduction process, It may also be necessary to increase the dose again, And prolonged the time of medication. For some critically ill patients, Hormone shock therapy may be used. The so-called shock therapy refers to the early use of super-large doses of hormone infusion needles to control the disease, then gradually reducing the dose and changing to oral drugs, and taking them for a long time to maintain the curative effect. Considering the possible adverse reactions of hormone shock therapy, these patients generally need to be hospitalized for observation and treatment in the early stage.
In addition, there is a local injection of glucocorticoid into the orbit. It can be used alone or in combination with the above two systemic therapies.
In addition to glucocorticoids, another drug to control inflammation is immunosuppressant.
It may produce more side effects than hormones, and is generally not the first choice at present. It is mostly used in some patients with poor hormone treatment effect, or it is combined with hormones to enhance the curative effect.
Another non-surgical treatment is radiotherapy. Radiotherapy also has a better effect on controlling orbital inflammation. This kind of radiotherapy is generally lower in dose and relatively less risky than radiotherapy for malignant tumors. Similarly, it can also be used in combination with hormone therapy to enhance the anti-inflammatory effect.
Most patients with thyroid-related ophthalmopathy can control inflammation and protect their eyesight after standardized drug treatment.
Can the medicine make the eye appearance change back to normal?
This is the concern of many patients. Unfortunately, it is almost impossible.
In one case, The patient’s exophthalmos occurred in a relatively short period of time, This indicates that the patient’s orbital tissue has developed more acute inflammatory edema. At this time, a larger dose of glucocorticoid may be used for treatment. Or give shock therapy. The main purpose of treatment is to save eyesight, but if the treatment response is good, exophthalmos, red and swollen eyelids, etc. may also be greatly improved. However, even if there is a significant improvement, it is unlikely to completely return to normal appearance.
If it is aimed at some slow-occurring eyelid retraction, exophthalmos, eye skew, and some secondary eyelid insufficiency, inverted eyelashes and other problems, there is no way to reverse the drug, and most of them need surgical treatment.