In mild cases, Thyroid Eye Disease (TED) can be treated with artificial tear drops, which will help your child’s eyes feel more comfortable. Treating the over-active thyroid and making sure that it doesn’t become under-active helps the eyes settle. Smoking and passive smoking make the eyes worse so it is important to make sure that your child is not exposed to smoke.

Treatment for more severe TED is rarely necessary but may include:

• Prisms attached to spectacles (to help the double vision)
• Occasionally high dose steroids (to reduce swelling)

The symptoms may worsen for the first six months and then your child’s eyes should settle down, although they may not return to their previous state. It can take up to two years before the inflammation disappears.

Rundle’s curve and the burning house

Rundle’s curve can be used to explain how TED develops. This is based on the work of an Australian surgeon called Frank Rundle who used the analogy of a burning house, which can help you and your child understand the stages of untreated TED.

Stage 1: House on fire

Rundle calls the first stage of TED the active phase. This can last from six to eighteen months. It is useful to think of this stage in terms of a house that is on fire. This is when your child’s eyes are red, sore and swollen. This can usually be treated with eye drops and careful observation but some children may need steroids to decrease the inflammation. Your child can think of this as fireman hosing water on the flames to put them out. Sometimes a child may need surgery if their vision is affected or if they have double vision.

Stage 2: The house is rebuilt

The second phase of TED is the plateau or static phase. TED can burn itself out naturally or you can have help through medication, or surgery. This means that the redness and discomfort stops. However, your child’s eyes may have been damaged like a house that has been damaged by a fire. This damage can include protruding eyes, a staring expression or double vision. Like workmen rebuilding a house, surgeons may have to repair and restore the appearance and function of the eyes.

 

The text above is adapted from 'Rundle’s Curve and the Burning House' by Dan Morris, Consultant Ophthalmologist, University Hospital of Wales, in the Thyroid Eye Disease Charitable Trust (TEDct) newsletter, spring 2010 edition, pages 13-16.

For more information about TEDct, visit: www.tedct.org.uk

Surgery

Although it's very rare, children and young people with TED can be left with double vision or a permanent change to the appearance of their eyes. This can be treated with surgery, which in severe cases may be combined with treatments such as steroids. There are three main types of surgery:

• Decompression surgery to create more space behind the eyes where there is pressure on the nerve. It can also improve the appearance of the eyes if they are protruding.
• Eye muscle surgery to treat double vision
• Eyelid surgery to improve the appearance of the eyelids.

We strongly recommend that your child’s surgery is performed by an ophthalmic surgeon who regularly does thyroid eye disease surgery. You should not hesitate to check your surgeon’s experience, such as the number of thyroid eye disease operations they do each year and their rate of complications, before you decide.