Categories
Health and Disease

Thyroid Eye Disease: Symptoms, Diagnosis, and Treatment

Introduction

Thyroid eye disease, also known as Graves’ eye disease, is an autoimmune condition in which the eye muscles and fatty tissue behind the eye become inflamed. The main symptoms of thyroid eye are red, uncomfortable, and “bulging eyes.” These are caused by inflammation of the eyelid, tear glands, muscles, and fatty tissue behind the eye. Occasionally, this inflammation can lead to stiffness in the muscles, which can cause double, or blurred vision, as eyesight is not aligned between both eyes due to not being able to move parts of the muscle. Thyroid eye is an autoimmune disease caused by an immune attack on the tissue around the eye, irritating it and causing inflammation. 

Most people suffering from thyroid eye disorder (or TED) have Graves’ disease, which can detrimentally affect the thyroid gland, usually causing hyperthyroidism (overactive thyroid). 25% of those with Graves’ disease will also develop TED sometime before or during treatment.  Those suffering from Graves’ disease will double their chances of developing TED by smoking. A person diagnosed with thyroid eye will likely be placed under the care of an endocrinologist (a doctor specializing in hormonal diseases) as well as an ophthalmologist (an eye doctor). These departments will be the first port of call during treatment and should be informed if symptoms worsen.

Symptoms and Diagnosis

One major issue associated with TED is how difficult it is to diagnose. Thyroid eye is usually mistaken for symptoms associated with hayfever, conjunctivitis, or allergies. There are signs that directly point to TED and not the aforementioned conditions: continuing symptoms all year around with no improvement in winter months, no stickiness around the eye, and no improvement of symptoms after trialling different allergy solutions. 

In order to reduce symptoms of thyroid eye, it is imperative the sufferer attempts to quit smoking, if they are in the habit. Furthermore, it is important that they listen to their doctor’s advice and are aware of their changing thyroid levels, as well as monitoring them and following medical advice (e.g. attending blood tests every six months). This can sometimes help to alleviate symptoms and reduce the chance of TED becoming more severe.

It is vital to recognize that TED massively impacts individuals’ lives. From self confidence, to eyesight, thyroid eye can affect your daily life. Many sufferers struggle with low self esteem and self consciousness due to their eyes having a “bulging” appearance. Double vision can also be frustrating, meaning those with thyroid eye can experience confusion, especially when reading or trying to understand someone’s facial expression. This can be taxing on the patient, as well as family and friends, so it is crucial that everyone researches how they can support their loved one. Charities such as the “Thyroid Eye Disease Charitable Trust” and the “British Thyroid Foundation” can offer support and advice to help patients come to terms with the condition and adapt their daily life for ease. 

Treatment

There are a range of different treatments to help with some painful symptoms of TED. Artificial tears can be used to reduce the feeling of “grit in the eye” that can be associated with thyroid eye disease. If inflammation is severe, a doctor may prescribe an oral steroid to reduce it, or administer steroids intravenously. Some patients also find that having prisms attached to glasses can reduce their double vision. There are also surgical options to fix double vision, protect the eyelids, create space in order to allow the eye to close better, and protect the eyeball. 

The best thing a family member can do for a loved one suffering from TED is support and listen to them. Any disease affecting eyesight can be extremely unnerving for the sufferer, as their independence decreases, they may have to become more reliant on those around them. Especially for adults, double vision can be frustrating as it makes day to day activities harder. Teenagers and young people may feel self-conscious about their appearances and the possibility of having to wear an eye patch to alleviate vision problems. A caretaker, friend, or relative, should offer help, but make sure to give them space and allow their loved one to attempt things independently. They should be careful not to sound condescending, be supportive, and if they are comfortable discussing it, talk to them about the condition and their emotions surrounding it. Before forcing their help upon someone, those close to a person with thyroid eye should communicate with them and ask what they would like you to do.

References

Douglas, Raymond S. “Thyroid Eye Disease (TED or Graves Eye Disease).” Thyroid Eye Disease (TED or Graves Eye Disease) | Kellogg Eye Center | Michigan Medicine, http://www.umkelloggeye.org/conditions-treatments/thyroid-eye-disease.

“Graves’ Eye Disease.” American Thyroid Association, http://www.thyroid.org/graves-eye-disease/.

MacEwen, Caroline. “Expert Opinion – Diagnosing Thyroid Eye Disease.” GP, GP, 14 Mar. 2012, http://www.gponline.com/expert-opinion-diagnosing-thyroid-eye-disease/ophthalmology/article/1120742.

“Thyroid Eye Disease.” British Thyroid Foundation, 2019, http://www.btf-thyroid.org/thyroid-eye-disease-leaflet.

“Thyroid Eye Disease.” Cleveland Clinic, my.clevelandclinic.org/health/diseases/17558-thyroid-eye-disease. 

Sophie Farr, Youth Medical Journal 2020

Categories
Health and Disease

Nystagmus: Types, Causes, and Treatments

Nystagmus is an involuntary shaking of the eye, or both eyes, similar to a twitch. They can move in different directions: vertical, horizontal, and in circular motions. Typically, nystagmus is a sign of another underlying eye or neurological condition. If someone has nystagmus, it can be picked up using special equipment and tests, one being the caloric reflex. The caloric reflex test is when a doctor, or nurse, gently runs either hot or cold water, or air, down one ear canal. If the patient has nystagmus, this test will stimulate it because of the temperature gradient.

One cause of nystagmus is an inner ear infection. Infections, such as labyrinthitis and vestibular neuritis, are known to cause nystagmus due to the eye attempting to compensate for the lack of balance. This is a similar effect as travel sickness; if the fluid in the ear is unstable due to an infection, you will feel as if you are constantly in motion, and the eyes and ears will be receiving different sensory messages. The eyes then overwork to attempt to regain equilibrium and balance, causing nystagmus. This particular type of nystagmus should resolve itself once the inner ear infection has been fought off. To diagnose this nystagmus, an ophthalmologist may get you to follow their finger up and down and side to side to check which direction triggers the shuddering of the eye.

Another type of nystagmus can be brought on by conditions such as albinism and develop in infants aged 2-3 months. This nystagmus, due to ocular albinism, is more common in male babies and early signs of it may include them tilting or “bobbing” their head to get a clearer vision. Other symptoms of albinism, which are likely to coincide with the nystagmus, are a lack of pigmentation in the iris and abnormal connection between the nerves on the retina and the brain. Treatment for ocular albinism includes glasses, which can improve vision greatly, as well as sun shields and rimmed headgear to reduce the effects of light sensitivity related to albinism.

One of the most common causes of nystagmus is a neurological condition, usually present since birth. Some conditions which can cause nystagmus include multiple sclerosis, Meniere’s disease, and strokes. Nystagmus due to multiple sclerosis is most often a result of the disease-causing damage to the cerebellum and affecting muscles, vision, and balance. In addition, certain medications for epilepsy can cause nystagmus due to how they interact with the brain. To diagnose what the root cause of the nystagmus is, a neurologist or ophthalmologist may suggest for you to get a CT scan or MRI of the brain to rule out any more sinister causes.

Being diagnosed with nystagmus can impact individuals’ lives. Not only could nystagmus be the first indicator of a more invasive disease, but it can also cause a decline in eyesight and make it uncomfortable to do normal things. Many people that suffer from nystagmus say that it is an unpleasant feeling and twitching can strain the muscles in the eye. Getting a thorough consultation with an ophthalmologist is the first step in improving your nystagmus related symptoms; they can consider whether you need glasses or other methods to control the symptoms.

A lot of sufferers, especially teenagers, may feel quite self-conscious about their nystagmus due to it being visible to other people. Stress and fatigue can also exacerbate nystagmus so sufferers must try to stay away from tense environments and keep good sleep hygiene. Anyone with nystagmus must remember that it is not anything to be embarrassed about or hide, it is involuntary and nothing to be ashamed of. Sufferers need to speak to their medical team to get more support with their condition and to ensure it is monitored for any signs of regression or progress.

References

“Labyrinthitis and Vestibular Neuritis.” NHS , NHS, 11 Feb. 2020, http://www.nhs.uk/conditions/labyrinthitis/.

“Nystagmus.” American Optometric Association, American Optometric Association, http://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/nystagmus#:~:text=and%20drug%20toxicity.-,What%20causes%20nystagmus%3F,stroke%2C%20multiple%20sclerosis%20or%20trauma.

“Nystagmus.” American Optometric Association, http://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/nystagmus#:~:text=Nystagmus%20is%20a%20vision%20condition,or%20in%20a%20circular%20pattern.

Wachler, Brian S. Boxer. “Nystagmus: Symptoms, Causes, Diagnosis, Treatment.” WebMD, WebMD, 7 Nov. 2019, http://www.webmd.com/eye-health/nystagmus.

Categories
Biomedical Research

Antimicrobial Resistance- What it is and Why it’s a Problem

During the lockdown, many museums and festivals have chosen to continue their yearly programs in a digital format. Some of the most famous events in the world of academia, such as the Hay Festival, have become free and available online, creating countless opportunities for individuals from all over the world to come together and learn. When I heard about the Hay Festival digital program, I was extremely excited and delved in and booked dozens of lectures with famous names such as Laura Bates, Gloria Steinam, and Stephen Fry. Although all of them were incredible, the one that stood out to me was “The Drugs that Don’t Work” with Dame Sally Davies. 

Sally Davies was the Chief Medical Officer for England as well as the Chief Scientific Adviser at the Department of Health. She started her career as a clinical practitioner and has pioneered research and advancements in many medical fields. The particular lecture I watched was based on her book of the same title, “The Drugs that Don’t Work”. The book is based on antimicrobial resistance, a deadly phenomenon afflicting the world. Antimicrobial resistance, or AMR, is when microorganisms change or mutate (change in the base sequence of the DNA)  after being exposed to an antimicrobial drug, such as an antibiotic or anti-malaria. This allows the microorganisms to become immune to the effects of the drugs and “superbugs”, such as MRSA, can develop.

MRSA, or Methicillin Staphylococcus Aureus, is a “superbug” which can cause infections in various areas of the body. And the main issue faced with MRSA is that it is resistant to most common antibiotics which allows it to spread rapidly in hospitals through contact, causing infections ranging from mild skin ones to life-threatening ones such as lung, blood, and surgical wound infections. For a while, it was a major problem in British hospitals, and many surgical patients were advised to bring their own hand towels to use for washing to ensure the towel wouldn’t drape along the floor and potentially have contact with the bacteria. It is estimated that 2% of the population will carry MRSA and it can be transmitted through touching someone with it or an object that a carrier has held. In hospitals now they still test you for MRSA before any operation and you will likely have a swab taken from the skin in your armpit, groin or nose to test for it. 

One of the things that were most poignant to me about her lecture was just how often antimicrobials are used in the farming and aquaculture industries. Many farmers use antibiotics to promote growth in plants and reduce the risk of infections. The antibiotics are a cheaper alternative to implementing infection control and hygiene measures so have been used excessively and unnecessarily. Not only this, but they are also used in aquaculture, the breeding, and farming of fish, to prevent and treat bacterial disease. These same antibiotics are used to treat human pathogens as well, so as they are used so frequently in farming industries, it allows them to adapt their DNA coding and become resistant to treatment. This is detrimental to human health and Sally Davies said that every year, more people are now dying of the effects of AMR than cancer. 

Are you shocked that you do not have much knowledge on an issue that could prove so deadly to the human race? Dame Sally Davies said that one of the greatest downfalls is the lack of education for the public on AMR. Although some people in the UK may be accustomed to the little “AMR song” they play in general practitioner surgeries, we have nowhere near enough exposure to the true risks of antimicrobial resistance. Sally Davies even went as far as to state that the effects of AMR could reduce the global GDP, gross domestic product, by 3.5% which is a significant loss.

In order to reduce the increase of antimicrobial resistance, there are a few measures that everyone can take. For example, it is imperative that you do not share prescriptions with others as If that person has a viral infection, and you are giving them antibiotics, the medication will not work and will increase the AMR in the microbiome in their gut. Misusing medication is one of the most dangerous things you can do, even if you are not talking about antimicrobial resistance. Furthermore, do not use any leftover prescriptions or self prescribe if you have not sought the advice of a registered doctor. Although you might think that there is no harm in trialing a medication, especially if you are experiencing similar symptoms as before, it is incredibly unwise to do this without going to your doctor first. 

This lecture was informative and shed light on a complex issue that may prove very dangerous in our future. Antimicrobial resistance needs to be addressed and it is important that the public is educated on it and how they can reduce their risk.