A 46-year-old smoker, surnamed Wang, from Taichung recently experienced blurry vision. Thinking he was getting more long-sighted as his eyes aged, he started wearing multifocal glasses, but these made things worse and he started getting double vision. He went to an optician for an eye test, and his vision was apparently normal, although he found he was having difficulty looking up with his right eye. A series of blood tests and CT scans revealed that there was a problem with his thyroid. The man quit smoking and was treated for hyperthyroidism, and started wearing single vision lenses and prism correction glasses. After this, his eyesight returned to normal.
According to Ku Wei-ning, an ophthalmologist at the Asia University Hospital, as there was no obvious sign of external trauma or history of bone fracture around the patient’s right eye, thyroid dysfunction or an orbital tumor were suspected. After the blood tests and scans were arranged, the problem turned out to be an overactive thyroid and antithyroid antibodies, in addition to inflamed fatty tissue around the extraocular muscle, which impeded the patient’s ability to rotate his eyeball. He was therefore diagnosed as having thyroid eye disease.
In addition to being referred to the metabolic disease department, the patient was also advised not to wear multifocal glasses and to wear single vision lenses and prism correction glasses instead. As smoking can exacerbate an overactive thyroid, he was also strongly advised to quit. Having followed these recommendations, the patient’s condition significantly improved.
Photo: Chen Chien-chih, Liberty Times
照片：自由時報記者陳建志
Ku says that thyroid eye disease typically leads to enlarged or bulging eyes and eyelid retraction, and some patients will also experience keratitis (inflammation of the cornea), become cross-eyed and experience double vision, while the inflammation of the fatty tissue around the extraocular muscle will make it difficult to rotate the eyeball. In serious cases it can cause pressure on the optical nerve, and this can lead to impaired vision.
According to Ku, if a patient has a serious case of thyroid eye disease, one option would be to undergo corrective surgery on the extraocular muscle. In the case of enlarged or bulging eyes, doctors could also consider endoscopic surgery to reduce pressure in the orbital cavity. The most serious cases of thyroid eye disease can lead to pressure on the optical nerve, and this will necessitate urgent endoscopic surgery on the orbital cavity to save the eyesight.
The vast majority of patients with thyroid eye disease only need to make regular appointments in the ophthalmology department and take their prescriptions, refrain from smoking and apply artificial tears. These steps will be sufficient to reduce the risk to their eyesight.
(Translated by Paul Cooper, Taipei Times)
台中一名四十六歲王姓男子有抽菸習慣，最近覺得眼睛看不清楚，以為老花眼變嚴重，特別配戴多焦點鏡片矯正，沒想到看東西歪斜，還會出現兩個影子，到眼科檢查後視力正常，但右眼卻無法向上轉動，經安排抽血、斷層掃描檢查，才發現是甲狀腺病變造成，經戒菸、治療甲狀腺功能亢進，並改戴單焦點鏡片、稜鏡矯正後，終於讓視力恢復正常。
亞大醫院眼科部醫師顧蔚寧表示，因患者右眼沒有外傷骨折病史，懷疑可能是甲狀腺功能異常或眼窩腫瘤，安排接受抽血與眼窩電腦斷層檢查，果然發現甲狀腺功能亢進與甲狀腺特殊抗體異常，且出現眼外肌肥厚，才會造成右眼無法向上轉動，確診為甲狀腺眼病變。
除轉介患者到新陳代謝科治療甲狀腺功能亢進外，也建議不要配戴多焦點眼鏡，改用單焦點鏡片加上稜鏡矯正複視，因抽菸會導致甲狀腺眼病變情況加劇，強烈建議他戒菸，患者配合後狀況大幅改善。
顧蔚寧表示，典型的甲狀腺眼病變會造成大眼、凸眼、眼瞼攣縮等症狀，部分患者則會有角膜病變、斜視與複視、眼外肌肥厚造成眼球轉動困難等狀況，嚴重甚至因壓迫視神經，導致失明可能。
顧蔚寧指出，若是嚴重甲狀腺眼病變患者，可經由眼外肌調整手術矯正，若眼睛變大、變凸，可做導航內視鏡眼窩減壓手術，而最嚴重的甲狀腺眼病變造成的視神經壓迫，需緊急做內視鏡眼窩減壓手術治療，以搶救視力。
大多數甲狀腺眼病變的患者，只要定期至眼科門診追蹤，並配合服藥，不抽菸、使用人工淚液保養，就能降低失明風險。
（自由時報）
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