Chennai, 10 February 2022: “The rate of incidence of Thyroid Eye Disease (TED), a complex, orbital inflammatory disease with sight-threatening complications, has increased by about 25% in Chennai, after the pandemic outbreak. Uncontrolled thyroid levels due to delayed diagnosis and treatment, and increased levels of stress during the pandemic can explain the alarming rise of TED,” said Dr Ashvin Agarwal, Executive Director & Head of Clinical Services, Dr Agarwal’s Eye Hospital.
Addressing a press conference in Chennai, Dr Ashvin Agarwal said that TED can be sight-threatening and debilitating. It is a disfiguring condition: the tissues behind the eyeball and around the eye become swollen, making the eye look bulgy. It gives the patient a staring appearance. The cosmetic disfigurement may lead to emotional and psychological problems. Thyroid eye disease is seen in patients with hyperthyroidism (also known as Graves’ disease) or hypothyroidism, which results chiefly from iodine deficiency. 10% of TED patients have normal thyroid levels in the body.
In her comments, Dr Priti Udhay, Head – Oculoplasty & Aesthetic Services, Dr Agarwal’s Eye Hospital, said, “During the pandemic, we have seen a rise in patients with thyroid eye disease. This could be because the Covid-19 virus can invade the thyroid gland and can trigger immune mechanisms. There is also the possibility of antiviral drugs affecting the gland. An indirect reason is the lapses in monitoring the thyroid levels during the pandemic, as the test labs and hospitals were out of bounds and patients avoided hospital visits due to fear of contracting Covid-19. Hence, the number of patients with uncontrolled thyroid levels have increased.”
TED is a complex autoimmune disease, and stress often triggers autoimmunity. “Stress can aggravate the disease and activation of eye disease is seen when patients experience traumatic life events like a divorce, loss of dear ones or loss of job.” Besides, rising awareness about the disease means that more patients with this condition are being diagnosed.
Dr Priti elaborated on the symptoms and warning signs of TED. “Common symptoms of TED are swelling of eyelids in mornings and sunlight; redness, discomfort and watering; double vision especially on prolonged reading; inability to completely close the eyes; decrease or blurring of vision noticed especially when one eye is closed. The cosmetic problems caused by TED are prominence and bulging of the eyes, staring appearance, squinting and puffiness of eyelids. The puffy eyelids in the inactive stage of thyroid eye disease is due to the prolapse of fat pads and not fluid collection. This will not get corrected on its own. Cosmetic surgery in the form of blepharoplasty can bring back the rested and rejuvenated appearance of the eyes.”
Dr. Priti also noted that the patients with uncontrolled thyroid disease, men, older individuals, diabetics, and smokers have a higher risk of developing a severe form of thyroid eye disease. Smoking and diabetes have detrimental effects on thyroid eye disease. Quitting smoking and diabetes control can go a long way in controlling eye disease.
Speaking on the treatment for the condition, Dr. Priti added that curing or stabilizing thyroid levels in the body may not cure the eye condition but it helps in better control. Hence, treatment for thyroid eye disease is necessary. The treatment for this condition has evolved greatly in recent times. The majority of patients in the active phase have only 8mild symptoms. Most of the symptoms in the active phase can be treated with medications like lubricants, steroids, radiotherapy, immunosuppressants, etc. In the inactive phase, most of the patients require surgery. However, the treatment varies based on the individual, the stage of disease, and symptoms.
Dr S. Soundari, Head of Medical Services, Dr Agarwal Eye Hospital, urged the at-risk population to opt for active screening for thyroid eye disease. “The only way to prevent severe disease is to keep thyroid hormone levels under control and get a regular examination with an oculoplastic doctor, specialised in ophthalmic surgery.”
She emphasized that early diagnosis is important because if left untreated the disease can be sight-threatening as it affects the cornea, optic nerve and can also raise the eye pressure and cause glaucoma. “Most of the signs of thyroid eye disease are reversible if diagnosed early and treated. We can now restore most patients to their normal appearance and function with timely intervention,” she pointed out.
The Doctor also added that Thyroid Eye Disease still does not get the attention it deserves among healthcare professionals. The array of treatments that oculoplastic surgeons provide is less known to the public. In addition to apathy, there is also a lack of standardized management protocols, as a result, there is no consistency in managing the patients.