Department of Ophthalmology, University of Maryland, 419 West Redwood Street, Suite 420, Baltimore, MD, 21201, USA.
Curr Treat Options Neurol. 2014 Aug;16(8):303. doi: 10.1007/s11940-014-0303-8.
Patients with thyroid eye disease (TED) experience hypertrophy of their extraocular muscles and an increase in intraorbital fat volume leading to eyelid retraction, proptosis, double vision, and optic nerve compression. These orbital changes are thought to be due to a cross-reaction of thyroid stimulating hormone (TSH) with antigens in the orbit. Therefore, the key to treatment is achievement of a euthyroid state in patients with abnormal thyroid function. Cigarette smoking is the strongest modifiable risk factor linked with progression and poor response to treatment. All TED patients should be counseled and offered help with smoking cessation. The treatment of TED symptoms must be customized to each patient, as the degree of orbital involvement can vary. During the active state, evaluation of sight-threatening compressive optic neuropathy and treatment of corneal exposure by an ophthalmologist is crucial to avoid irreversible damage. In most patients, local therapy with artificial tears, gels, and ointments can offer symptomatic relief of irritation and dryness. In addition, antioxidant therapy with selenium has been shown to improve quality of life in patients with mild orbital involvement. Some patients will require systemic oral or IV steroids at the onset of an active inflammatory state. However, approximately one third of patients will not be responsive to steroid therapy alone. In these patients, the addition of orbital radiation or use of immune modulation has shown value. Orbital decompression surgery should be considered for cases of vision-threatening optic neuropathy despite maximal medical therapy. Approximately 3-6 months after cessation of the active state and stabilization of symptoms, rehabilitative treatment may be offered. Treatment is offered in a 3-stage surgical approach with orbital decompression surgery, followed by strabismus surgery for any resultant binocular diplopia, and finally eyelid surgery to address eyelid retraction. Meanwhile, symptomatic diplopia may be addressed with monocular patching or prisms.
甲状腺眼病（TED）患者的眼外肌会发生肥大，眶内脂肪体积增加，导致眼睑退缩、眼球突出、复视和视神经受压。这些眼眶变化被认为是由于促甲状腺激素（TSH）与眼眶中的抗原发生交叉反应所致。因此，治疗的关键是使甲状腺功能异常的患者恢复甲状腺功能正常。吸烟是与疾病进展和治疗反应不佳最强相关的可改变的危险因素。所有 TED 患者都应接受咨询并提供戒烟帮助。TED 症状的治疗必须根据每个患者的情况进行定制，因为眼眶受累的程度可能会有所不同。在活动期，评估眼科医生治疗有视力威胁的压迫性视神经病变和治疗角膜暴露对于避免不可逆转的损伤至关重要。在大多数患者中，局部使用人工泪液、凝胶和眼膏可以缓解刺激和干燥等症状。此外，抗氧化治疗用硒已被证明可以改善轻度眼眶受累患者的生活质量。一些患者在活动期炎症状态开始时需要全身口服或静脉内类固醇治疗。然而，大约三分之一的患者单独接受类固醇治疗不会有反应。在这些患者中，添加眼眶放射治疗或免疫调节已显示出价值。尽管进行了最大程度的药物治疗，但对于有视力威胁的视神经病变的患者，仍应考虑进行眼眶减压手术。在活动期停止且症状稳定后大约 3-6 个月，可以提供康复治疗。治疗采用 3 期手术方法，首先进行眼眶减压手术，然后针对任何由此产生的双眼复视进行斜视手术，最后进行眼睑手术以解决眼睑退缩问题。同时，可通过单眼遮盖或棱镜来解决有症状的复视。
