By David Hurst
Published: 17:58 EST, 10 November 2012 | Updated: 17:58 EST, 10 November 2012
Vision in peril: Comic Maaty Feldman was a Graves' disease sufferer
Patients with a common hormone imbalance – who would once have faced bulging eyes and blindness – can have their sight saved thanks to an operation through the nose.
This risky procedure used to be carried out at only a few teaching hospitals, but is now becoming more widespread.
Thyroid disease occurs when the body produces too much or too little of the thyroid hormone. Sufferers of an underactive thyroid, a glad in the neck, often feel exhausted and suddenly put on weight. The condition affects one in ten Britons and is usually treatable with daily pills.
In extreme cases, however, these medicines cause the body to go into overdrive as if it has been flooded with too much of the thyroid hormones.
This shift in levels can cause eyes to swell to such a large, bulging size that eyelids will no longer close over the top, vision becomes blurred and patients can lose their sight.
The condition, known as thyroid eye disease, which also occurs in people with an overactive thyroid, is usually treatable with drops.
In one in 20 cases, patients will need a specialist and quite dangerous operation to make the eye socket larger so the eyeball can be popped back in and sight can be saved.
Doctors perform it by going up into the eye socket through the nose while making only a tiny, single incision under the eye.
One patient who has had the new procedure is Julia Clarke, 51, from Doncaster, Yorkshire. She went from having normal eyesight to near-blindness in 2010 after taking tablets to treat her underactive thyroid.
Julia says: ‘My thyroid suddenly became too active and this caused the tissue around my eyeballs to swell at the top and bottom. It became so bad I couldn’t close my eyelids and I started to get infections. This happened within weeks and was very scary.’
The cleaner was advised to stop taking the thyroxine tablets and referred to Omar Hadid, consultant eye surgeon at Doncaster Royal Infirmary.
He gave her eye drops for the dryness and monitored her eyes. Soon he realised Julia had developed a severe form of thyroid eye disease, which can also be called thyroid ophthalmopathy, ophthalmic Graves’ disease or dysthyroid eye disease.
The condition is triggered when white blood cells, which normally defend the body from infection, see the thyroid gland as foreign material and attack it. This stimulates the thyroid gland to produce extra thyroid hormones and this attacking process may spill over to the cells behind the eye, causing them to swell.
Help at hand: Sufferers can now be treated for the condition with an operation on the eye socket through the nose
It is not known why these cells develop the fault that causes them to attack the thyroid gland or why some patients with overactivity of the thyroid or those on thyroid pills develop thyroid eye disease.
What is known is that smoking increases the risk eight times. It usually develops between the ages of 30 and 50 and affects 16 in 100,000 women in the UK annually, and three in 100,000 in men.
Julia’s sight was deteriorating, particularly in the right eye. In spite of intensive treatment with steroid injections, her eyeballs continued swelling, which she was warned would most likely lead to permanent blindness.
Her right eye had deteriorated so far that an operation was the only chance of saving her sight. In October 2011, Mr Hadid performed the three-and-a-half hour operation, known as orbital decompression, on Julia’s right eye.
Instruments are inserted into the nose to reach the back of the eye, and a small incision less than half an inch long is made on the lower eyelid beneath the lashes.
Surgeons can then remove bone at the back of the eye socket and suck out any excess fat to help take pressure off the optic nerve and allow more space for the eyeballs to go back in.
‘Orbital decompression involves expanding the bony walls of the eye socket,’ says Mr Hadid.
‘It used to be carried out only at a few specialist teaching hospitals because such extensive surgery for decompressing the optic nerve is not only high-risk but challenging, owing to the nature of the inflamed and swollen tissues.
‘However, it is now becoming more widespread and without it Julia would have developed permanent loss of sight. Her vision in the operated eye improved to normal within 24 hours.’
After a month, the swelling had reduced, and in February Julia was told it was unlikely she will need a similar operation on her left eye. ‘I could have been blind by now if I’d not had the operation,’ she says.
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