Corneal lesions in case of endocrine ophthalmopathy: prevention and treatment

Ligita Bespalovaitė1, Karolina Buožytė1, Gabrielė Baltrūnaitė1, Rasa Liutkevičienė2

1Lithuanian University of Health Sciences, Faculty of Medicine, Kaunas, Lithuania

2Department of Ophthalmology, Kaunas University of Medicine, Kaunas, Lithuania, Institute of Neuroscience, Laboratory of Ophthalmology, Kaunas University of Medicine, Kaunas, Lithuania



Graves’ ophthalmopathy, thyroid – eye disease or orbitopathy associated with the activity of the thyroid gland is an immune mediated inflammatory disorder involving soft tissues (periorbital edema, conjunctival swelling), eyeball protrusion (frontal displace of the eye), double vision (diplopia), corneal damage and compression of the optic nerve. Graves’ ophthalmopathy is the most common and important extrathyroid expression of Graves’ disease. Greives’ ophthalmopathy is divided into three types: non-infiltration, infiltration, ophthalmopathy. The clinic is characterized by general symptoms of Graves’ disease: rapid and irregular heart rhythm, frequent defecation, enlarged thyroid gland, heat loss, nervousness, irritability, fatigue, shaking hands, weight loss. Also, symptoms of Graves’ ophthalmopathy: severe eye pain, blurred vision, bulging eyes, corneal opacity, lagopthalmus, bright or swollen disc of the optic nerve. Treatment is based on the severity and activity of Graves’ ophthalmopathy. For those with vision-threatening ophthalmopathy, first-line treatment is immunosuppressive or anti-inflammatory, but if the response is poor or the disease is inactive, immediate surgical intervention is required. Treatment of corneal changes: it is advisable to use topical ointments and antibiotics frequently (every hour). If these and other measures, such as instillation of topical ointments or antibiotics, are not sufficient to prevent corneal ulceration and perforation, temporary measures are needed to improve the closure of the eyelids. These include blepharoraphia, tarzoraphy, eyelid adhesion, amniotic membranes, and botulinum toxin. When dealing with an acute situation, it is necessary to constantly improve the closure of the eyelids. A corneal transplant may also be needed. Tarzoraphy is the joining of part or all of the upper and lower eyelids in such a way as to close the eye partially or completely. This procedure is used temporarily to heal the cornea or to protect it during a period of illness. This procedure can also be used for a longer period when the cornea needs to be protected from the risk of long-term damage. The amniotic membrane has anti-inflammatory and antimicrobial properties and the least immunogenicity, which is useful in the treatment of the eye. The main prevention method is the elimination of risk factors. Databases reviewed: Pubmed, Medscape, UpToDate.

Keywords: Graves’ ophthalmopathy, corneal damage, corneal treatment, prevention.