For patients with eye socket disorders involving multiple specialties, adequate diagnosis and treatment is crucial. Ophthalmologist Drs. Özlem Engin (UMC Utrecht), whose area of interest includes disorders of the eye socket, lacrimal ducts and eyelids, talks about the importance of multidisciplinary care for patients with Graves’ disease and idiopathic orbital inflammation (IOI).
Multidisciplinary care for patients with Graves’ disease
According to Engin, an important recent development in ophthalmology is the establishment of multidisciplinary care. Certain conditions lend themselves well to this, such as Graves’ disease, an autoimmune disorder associated with hyperthyroidism and sometimes also with Graves’ ophthalmopathy or orbitopathy. This involves an inflammatory reaction of the fat and muscles in the eye socket. “Other clinics and we too try to center these patients as much as possible and see them multidisciplinary at once,” Engin explains. “This means that a peripheral ophthalmologist sees the patient and refers him (with the exception of patients whose Graves’ disease is very quiet and does not cause eye problems). With referred patients, we aim to have some imaging already done at the peripheral ophthalmologist. Then these patients then come to a combined consultation hour with an ophthalmologist and endocrinologist. Sometimes an orthoptist is also present. When patients come, everything is immediately discussed: what is the ophthalmological status and the internist checks the state of the thyroid gland. Patients will then immediately receive a plan.”
Cause
Graves’ disease does not necessarily have a genetic cause, says Engin. “Anyone who has thyroid disease can develop Graves’ disease. It is an autoimmune disorder in which autoantibodies also bind to tissue, including in the eye. This results in infiltration of inflammatory cells into orbital tissue. The largest group consists of people with a fast-acting thyroid gland, followed by a normal thyroid gland or a slow-acting thyroid gland.” Smoking is the main risk factor for the onset and severity of the disease. “We advise patients to stop smoking for that reason,” says Engin. “In smokers, the eye disease is more severe and it comes back more often. In a non-smoker with Graves’ disease, the eye problem normally occurs once and then extinguishes.”
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