Dysthyroid orbitopathy, or thyroid eye disease, is an autoimmune disease process. The muscles of the eyes and fatty tissue around the eye swell, causing a bulging eyes, eyelid retraction, and possibly even vision impairment. Often, dysthyroid orbitopathy is associated with hyperthyroidism, a disease that occurs when the thyroid gland secretes excess hormones. Diagnostic procedures include testing for hyperthyroidism, and a series of examinations performed by an ophthalmologist. To treat the swelling and inflammation, corticosteroids may be prescribed and thyroid function is normalized with the help of an endocrinologist. In cases which do not adequately respond to medications, surgical decompression of the orbital cavity may be performed. This allows the swollen tissue to prolapse or herniate into the sinuses, relieving pressure on the eye and optic nerve, and allowing the eye to sink back into its native position.
Tearing (epiphora) is characterized by overflow of tears. This occurs when tears are unable to drain into the nose through the nasolacrimal system. Tears are produced in the lacrimal gland in the outside corner of the eye, and cross the eye into the lacrimal sac, which directs the tears into the nose through the nasolacrimal duct. When there is obstruction of this duct, drainage of the tears cannot occur and they accumulate externally. Nasal blockage could occur from a variety of causes, such as inflammation, infection, structural defects, trauma, or growths. Proper diagnosis requires thorough examination and testing by an ophthalmologist. In some cases, opening of the lacrimal sac is recommended, and can be performed in a minimally-invasive endoscopic outpatient procedure known as endoscopic dacryocystorhinostomy (DCR). For further information, please refer to the American Rhinologic Society patient information section on DCR written by Drs. Ramakrishnan and Kingdom.
Orbital tumors may occur anywhere in the orbit, the bony cavity that houses the eyeball, muscles, fat, and nerves and arteries of the eye. The orbit and sinuses have a shared common boundary. In some cases, this can be exploited to access nearby tumors with an endoscopic approach through the sinuses. Orbital tumors can be benign or malignant, and may require a biopsy to diagnose. A video interview with Dr. Ramakrishnan is available on the website that discusses this approach.