There are six muscles involved in controling eye movement and a number of conditions can cause them to become enlarged.
The most common cause is probably thyroid eye disease, which is associated with Graves disease of the thyroid. It is an autoimmune condition in which the body's immune system attacks proteins on the thyroid gland causing it to go into overdrive.
Similar proteins happen to be found in the eye socket, and patients with Graves disease can develop inflammation in the eye socket which can affect the muscles. Because the eye socket is a confined space, any inflammation within it creates compressive symptoms.
Muscle function can be affected, leading to incorrect muscle balance and squint (the eyes being misaligned with respect to each other), giving double vision
. It is also possible that the pressure in the socket displaces the eyeball forward causing the eyes to look 'prominent' and making the eyelids look retracted (widely open). The eyelids and soft tissue around the eyes can also look swollen.
The spectrum of severity can vary quite a lot from patient to patient. Some get very mild eye problems, others can have significant difficulties. The treatment of thyroid eye disease can therefore be complex and has to be tailred to each patient individually.
- symptom relief with lubricating drops (for dryness)
- anti-infmmatory treatment with steroids or immunosuppressants
- surgery to relieve pressure in the eye socket
- prisms or surgery to address squint
- lid surgery to address lid function and appearance
The course of the thyroid eye disease can run over several years but typically the congestive flare-up phase is followed by a burn-out phase, in which inflammation gradually resolves, sometimes leaving scarring within the socket. Anti-inflmmatory treatment is often required during the congestive phase.
A rheumatologist may have been mentioned because they have expertise in administering and supervising immunosuppressants.
If your main symptoms are of dryness and surface discomfort, you may benefit from regular warm compresses to optimise the quality of the tearfilm. (Moist warm flannel applied to the closed eyes for 10 minutes at a time -- do not burn yourself!).
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