Intraocular Pressure and Glaucoma in Thyroid Eye Disease

Abstract

Purpose: Current literature lacks a summary of knowledge on intraocular pressure (IOP) elevation and glaucoma in thyroid eye disease (TED). This review aims to augment existing literature by providing such a summary. It qualitatively evaluates current knowledge on the pathogenesis, prevalence, and management of concomitant ocular hypertension or glaucoma in TED patients.Methods: In this narrative review, relevant publications were identified through a computerized database search. Search results were screened for relevance. Correspondence, Editorials, and Letters to the Editors were excluded. References cited within the identified articles were used to further augment the search. Information extracted for qualitative analysis included epidemiologic data, methods of IOP assessment, management protocols, and response to treatment.Results: Studies in current literature are relatively heterogenous, differing in country of origin, TED cohort sizes, and IOP measurement techniques. Further studies are required to elucidate the true epidemiologic relationship between TED and ocular hypertension or glaucoma. Proposed models of IOP elevation include elevation of episcleral venous pressure, mucopolysaccharide deposition within the trabecular meshwork, restrictive myopathy, steroid-induced glaucoma, and secondary glaucoma. IOP-reducing effects of TED treatment options are discussed.Conclusions: While raised IOP in TED is a common phenomenon, the diagnosis of glaucoma in TED requires a high index of suspicion before any intervention.

Associations Between Thyroid Eye Disease and Glaucoma Among Those Enrolled in the National Institutes of Health All of Us Research Program

“…In contrast, other studies defined glaucoma based on history or examination findings, including intraocular pressure (measured using a variety of techniques), prescribed glaucoma medications, and glaucomatous visual field defects, among others. 6,16,24,27…”

“…Betzler et al 6 described how understanding the epidemiological connection between TED and glaucoma is challenging, as anterior segment disease among TED patients can make imaging and diagnosis of visual field defects difficult. Moreover, the comorbidity of dysthyroid optic neuropathy, which can affect 3%–7% of TED patients, 28 can be mistaken for glaucomatous visual field defects and obfuscates the diagnosis.…”

“…Moreover, the comorbidity of dysthyroid optic neuropathy, which can affect 3%–7% of TED patients, 28 can be mistaken for glaucomatous visual field defects and obfuscates the diagnosis. 6 These potential biases may be partially mitigated by studying TED patients who are treated at a variety of institutions, as was done in this study. However, as this is the first US-based study to use multicenter electronic health record data, it is difficult to draw direct comparisons with prior literature.…”

“…6 Second, the outflow of aqueous humor in some patients may be impeded by increased episcleral venous pressure resulting from external pressure on the globe. 6–8 In other patients, there may be mucopolysaccharide deposition in the trabecular meshwork with increased outflow resistance. 9–11 Third, TED is associated with chronic surface and anterior chamber inflammation and formation of peripheral anterior synechiae, which may cause outflow resistance and secondary angle closure.…”

Impact of Systemic Comorbidities on Ocular Hypertension and Open-Angle Glaucoma, in a Population from Spain and Portugal

“…In a population-based study of the elderly participants in the Blue Mountains Eye Study [ 67 ], thyroid dysfunction was found to be independently related to OAG. Other authors have mainly considered the relationship of thyroid-associated orbitopathy and glaucoma [ 68 ]. In our cohort, hypothyroidism or hyperthyroidism was present in 19% of the OHTG and 14% of the OAGG.…”