Bulging eyes, double vision, and feeling unwell: Could be a thyroid eye disease

Singapore – September 2022, Madam Goh Sok Chiang She began to see things around her in two-dimensional form, or 2D.

For example, when in a crowd of people, she had difficulty perceiving depth. And when she entered a brightly lit shopping mall or supermarket, her vision became a mess.

“I forgot what 3D felt like after a while,” he added. Palliative care nurse. “It wasn't the normal way of looking at things anymore. It was very confusing and very obvious. Sometimes I would just use one eye to look at the area before I headed there.”

Madam Goh, now 62 years old, was suffering from thyroid eye disease (TED). Thyroid eye disease is a rare autoimmune disease that causes inflammation of the eye muscles and fatty tissue behind the eyes, causing the eyes to push forward and causing the eyes and eyelids to become red and swollen.

For some people, their eyes become misaligned, causing them to see double. In rare cases, TED can compress the nerves at the back of the eye or cause ulcers in front of the eye, causing blindness.

The incidence of TED is approximately 19 out of 100,000 people per year worldwide. According to the National University Hospital (NUH), the prevalence of TED in Singapore is 1% to 2% of the population, or an annual incidence of 30 to 50 per 100,000 people.

Despite having the word “thyroid” in its name, Approximately 30 per cent of TED patients do not have thyroid disease but still develop TED, said Adjunct Associate Professor Gangadhara Sundar, senior consultant in ophthalmology at NUH.

This is one reason why this condition is often misdiagnosed as allergic conjunctivitis or dry eye.

Professor Sander also said that not all people with TED show redness in their skin, especially Asians, who tend to have darker skin.

If TED is diagnosed early, artificial tears may be given to relieve eye dryness in mild cases. However, if it is discovered late, surgery may be required.

The surgical procedure involves orbital decompression, which removes bone and soft tissue behind the eye to create more space. Strabismus or eye muscle surgery to treat misaligned eyes. Ocular myotomy to correct severe diplopia. Eyelid surgery to improve the appearance and function of the eyelids.

At NUH, a dedicated TED clinic handles approximately 50 newly diagnosed and referred cases annually from Singapore and the South East Asia region. Patients include both children and adults.

Madam Goh told The Straits Times that the eye disease happened suddenly.

“I could see the blurry text on the computer and wondered how my eyesight had deteriorated so quickly,” said the grandmother of two.

“(One time) I had to light a candle, but the light was so dim that I couldn't aim at the wick. My colleague had to help me.”

Her co-workers were also concerned that her eyes looked swollen.

Mrs Goh said: “My eyeballs were already pulled to one side and I started squinting. I also couldn't grasp The colors are red and black. ”

She bought new glasses because she thought there might be a problem with her glasses, which were made about five years ago.

When that didn't work, she decided to consult an eye doctor. And the eye doctor told her: Suspecting that she had TED, he immediately referred her to his colleague who specializes in this disease.

“She said I should undergo decompression surgery, but I was worried at the time, so I decided to seek a second opinion at NUH,” Madam Goh said.

In August 2023, she underwent two surgeries to correct the misalignment.

“After the surgery, the first thing I thought was that the sink at home was deep. It's been a long time since I've seen that depth,” Madam Go said with a laugh.

Unlike her, Yeo Min Kong, 66, a retired glass contractor, did not have the classic signs of TED: bulging eyes and intermittent wide gaze.

Instead, he suffered from severe eye pain and swelling and “felt like there was sand in his eyes all the time.” His facial appearance also changed significantly, with his left eye bulging and the eyelid becoming severely droopy and swollen.

“Once, there was a child who got scared when he saw me and started crying. He felt so sick after that that he only went out when necessary,” Yeo said.

That was in mid-2018.

“At that time, I lost my appetite and started losing weight. I went from 82kg to 51kg in less than a month. My friends felt something was wrong and insisted I see a doctor. I did,” he said.

After a series of blood tests, he was referred to Professor Sander and told that he had TED.

Mr Yeo said: “I was almost blind when I met Professor Sander. He told me there was a black spot in the middle of my vision and that I needed surgery.”

he decided that Close your business permanently and retire.

“I made sure all my projects were completed, I sold my business, I used that money to pay my employees and send them home. I already He was approaching 61 years old and was planning to retire. I didn’t even have the courage to drive,” he told ST.

But Mr. Yeo had another illness. problem.

Professor Sander said: “We had to call in a neurologist and then Mr Yeo developed pancreatitis. His double vision was among his concerns as we had to sort out the rest. He underwent a total of seven surgeries to save his life.

Although his vision and appearance have improved significantly, Mr. Yo continues to wear special lenses to accommodate his lingering double vision. Despite the challenges, he remains deeply grateful to the NUH team.

“At least I can continue to cook for my wife, which is a lot of fun,” he said.

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