Thyroid Eye Disease at Pantheo Eye Center

Thyroid Eye Disease at Pantheo Eye Center

What is thyroid eye disease?

Thyroid eye disease (TED) is an autoimmune disease in which the eye muscles and fatty tissue behind the eye become inflamed. This inflammation can push the eyes forward or cause the eyes and eyelids to become red and swollen. In some individuals, the inflammation may involve the eye muscles, causing the eyes to become out of line, leading to double vision. In rare cases, TED can cause blindness from pressure on the nerve in the back of the eye or ulcers that form on the front of the eye.

TED is an autoimmune disease, meaning that the inflammation and scarring are caused by an attack from the body’s immune system. TED is primarily associated with an over-active thyroid gland due to Graves’ disease, although it can rarely occur in patients with an under-active or normally functioning thyroid gland.

Thyroid disorders affect multiple organs and as a result several clinicians from different specialties might be involved in your care. Further, treatments for TED also involve different specialties including ophthalmologists, endocrinologists, neck and head surgeons, rheumatologists and radiology oncologists.

The multidisciplinary team at Pantheo Eye Center works closely with all members of the extended team to best manage your condition.

Referral pathway

Patients with thyroid eye disease may present to Pantheo eye center via three main routes:

Referred by their endocrinologist for an ophthalmic evaluation with a known diagnosis of thyroid disorder.
Referred by a colleague ophthalmologist for sub-specialised ophthalmic care.
New onset eye symptoms with no known thyroid history.

Patients referred with a known diagnosis of thyroid disorder undergo an ophthalmic evaluation based on the guidelines of the European Group on Graves’ Orbitopathy (EUGOGO). Patients with new onset eye symptoms of unknown aetiology have a routine ophthalmic examination. If thyroid disease is suspected, the patient is referred for blood investigations and assessment by an endocrinologist.

At Pantheo Eye Center, we host a bimonthly joint clinic with an endocrinologist where we review complex TED. We evaluate each patient, discuss their case with the rest of the multidisciplinary team and devise an appropriate management plan.

What happens when you arrive at Pantheo Eye Center

All patients with TED have an ophthalmic evaluation based on the EUGOGO guidelines. There are two EUGOGO proformas for eye assessment:

1) for new patients

2) for follow-up patients

These proformas allow your doctor to collect all the relevant information to be able to make a clinical judgement for your care.

On your arrival at Pantheo eye center:

The nurse will measure your vision and the pressure of the eye.
Your ophthalmologist will take a comprehensive medical history.
Your ophthalmologist will examine your eye and take specific measurements related to TED.

We recommend you always bring the following to each of your visits:

An up-to-date written list of your medications
Bring all your glasses (near and distant correction) for the measurement of your vision.
Recent blood investigations, especially your thyroid hormone levels and thyroid antibody levels.
Any brain and/or eye imaging reports and CD with the actual images.
Any results of previous eye tests.
Any relevant reports from other doctors.

What eye examinations are performed?

The following eye tests will be done at your visit:

Measurement of your vision
Measurement of your eye pressure
Check of your colour vision which gives an indication whether your optic nerve is under pressure.
Check of pupil responses to light which gives an indication whether your optic nerve is under pressure.
Assessment of your eye movements for double of vision.
Measurement of exophthalmos (how much the eyes bulge forward).
Examination of the front of the eye for signs of inflammation and dryness
Dilated fundoscopy for examination of the optic nerves and internal structures of the eyes. To do this eye drops that dilate your pupils are necessary which will blur your vision for 2-4 hours. We recommend you do not drive for 2-4 hours while your vision is blur.

Certain patients will require more extensive investigations:

If you have double vision, your ophthalmologist will refer you to see the orthoptist (specialist who assesses eye movements). Our in-house orthoptist will assess your eye movements with special tests and might perform a Hess chart examination. The tests are regularly repeated to assess progression of the disease and response to treatment. Prisms or fogging occluders might be incorporated in the glasses if indicated to treat your double vision.

If your ophthalmologist is concerned that your optic nerve is under pressure, they will recommend you have OCT imaging of the optic nerve and visual field tests. These will be repeated at follow-up visits to monitor progress and response to treatment.

All necessary equipment are available at Pantheo eye centre, and tests are carried out by our highly trained technician. Our multi-disciplinary team is available at all hours to support our TED patients with their eye symptoms but also offer practical advice and psychological support when needed.

Treatments for thyroid eye disease at Pantheo eye center

Following your eye consultation, your ophthalmologist might recommend specific treatments. The treatment plan is tailored to each patient’s clinical presentation and will be discussed in detail with you. There are set-up pathways for each treatment:

Intravenous steroid treatments are delivered in a hospital setting as a day case. This is available at Pantheo eye center where the treatment is supervised by your caring ophthalmologist, a specialised nurse and our anaesthetist. Alternatively, this treatment is also available at all major hospitals and can be organised by your ophthalmologist.
Orbital radiotherapy for TED is delivered at specialised centres. There are two centers in Cyprus:

German Oncology Centre, Limassol, the responsible clinician is Dr Konstantinos Ferentinos
Bank of Cyprus Oncology Centre, Nicosia, the responsible clinician is Dr Marilena Theodorou

Orbital decompression surgery for TED is a highly specialised operation performed by few eye surgeons. We collaborate with two surgeons:

Dr Ioannis Kyprianou, Nicosia, Cyprus
Mr George Kalantzis, St James University Hospital Leeds, UK and Athens, Greece

Strabismus surgery might be recommended by your ophthalmologist if you have permanent double vision. There are two surgeons at Pantheo eye center performing strabismus surgery:

Dr Theodoros Potamitis, Pantheo Eye Center
Mr Manoj Parulekar, Birmingham Women’s and Children Hospital and the Oxford University Hospitals, UK

Eyelid surgery might be required for improving ocular surface, eyelid position and appearance. At Pantheo eye center there are two oculoplastic surgeons performing eyelid surgery:

Dr Eleni Topouzi, Pantheo Eye Center
Dr Antigoni Koukkoulli, Pantheo Eye Center

Meet the multi-disciplinary team

Antigoni Koukkoulli

Neuro-ophthalmology specialist and Oculoplastic surgeon

Responsible clinician for the management of patients with TED at Pantheo eye center. She performs the primary assessment, co-ordinates management and monitors patients long-term. She also performs cataract surgery and eyelid position surgical correction when indicated.

She is responsible for organising continuous education of staff members and colleagues; and leading all research/ projects in relation to TED.

Amalia Sophocleous

Head Orthoptist

Responsible for performing ocular motility examinations and Hess chart tests for our thyroid eye patients. She provides optical devices that address diplopia and offers practical advice to patients. She is also trained to offer low vision aids for patients with severe visual impairment.

Theodoros Potamitis

Vitreoretinal surgeon

Responsible clinician for vitreoretinal surgery and managing patients with complex retinal and vitreoretinal pathology.

Katia Papastavrou

Glaucoma specialist

Responsible clinician and surgeon for our patients with glaucoma disease.

Michalis Palos

Anterior segment specialist

Responsible clinician for our patients with corneal disease.

Loukiana Tsierkezou

Ocular inflammation and retinal specialist

Responsible clinician for our patients with complex ocular inflammation and retina disease.