What is thyroid eye disease ? thyroid associated ophthalmopathy (TAO), thyroid orbitopathy, Graves’ orbitopathy or Graves’ ophthalmopathy (GO) ?

Thyroid eye disease (TED) is an eye condition that causes the muscles and soft tissues in and around your eye socket to swell. It usually happens when you have a problem with your thyroid gland. It may also be called thyroid associated ophthalmopathy (TAO), thyroid orbitopathy, Graves’ orbitopathy or Graves’ ophthalmopathy (GO).

The ocular manifestation of thyroid eye diseases are manifolds. They may be present as thyrotoxicosis, lid retrac- tion, soft tissue involvement, proptosis and optic neuropathy.
        The Thyrotoxicosis (Graves dis- eases)
        Usually present with 3rd to 4thdecades of life, women are mostly effected than the men with involvement organ specific autoimmune disorders. Thyroid eye diseases may be present as a simple eye discomfort to blind- ness, which may be due to exposure keratopathy, optic neuropathy.
       The risk of developing thyroid eye disease recioprocate with smoking; hence giving up of smoking seems to reduces the risk of ocular menifestation of Pathological thyroid. Women are more prone than man and use of radio- active iodine to treat a hyperactive thyroid increases the incidence thyroid eye diseases.
      The inflammation of extraocular muscles and inflammatory celluar infil- toxins gives some relieved.
         Proptosis may be axial, unilateral Or bilateral and may be symmetrical or
trations caused by IgG antibody is thoughtto the of pathophysiology of thyroid eye diseases.

The clinicalpresentation of thyroid eye diseases may be as follows:

      Soft Tissue Involvement may present as discomforts of the eye, gritiness, photophobia, lacrimation, and hyperemia, and swelling of the orbit, keratoconjuntivitiesand features of dry eye syndrome. Conditions to be treated with frequent use of lubrecants, head to be elevated to reduce the pe- riorbital oedema, and eye lid taping may alleviate mild exposure keratopathy.
      Lid Retraction occurs to upper and lower lid in about 50% of patients with Graves diseases. The upper lid margin rest below the limbus or eye gaze strait with bu!ging showing the sclera (sclera show). Sometimes lid retracts in primary gaze, frightened appearance of eye in attentive gaze. Disinsertion of Muller's muscle, reces- Sion of lower lid and use of Botulinum cal decompression is suggested
     In Restrictive Myopathy (Ophthalmoplegia), the ocular asymmetrical There may be restriction of the eye movement, eye is proptosed may develop exposure keratopathy, comeal ulcertaion as lid may be unable close properly. Use of steriod (oral pednesolone / ivmethyl predene solone) in progressive and painful - proptosis during congestive phases gives relived to this type of condition. Radiotherapy may be used in addi- tion to steriodj is also effective. A com- bined therapy with irradiation, azathioprime and use prednesolone and in some cases of proptos surgi-motility is restricted initially by inflam- mation and later by fibrosis.Surgical maneuvering or injection of Botulinum toxins is useful in few restrictive myopathy.
      Optic Neuropathy may present with impairment of central vision, may lead to severe permanent visual {oss or in sometimes preventable visual impairement. Initially iv methyl prednesolneis used and later, surgical decompression done.