Some diseases present symptoms so common that they can be confused with other usual and milder conditions. This is the case of thyroid eye disease, which initially may manifest symptoms common in other conditions, such as redness or mild inflammation, but can end up triggering double vision and acute vision problems. "The complete disease affects 100% of the patient's work and social life," explains Dr. Sabina Luna, an ophthalmology specialist at Sant Pau Hospital. It is a rare, but progressive and debilitating condition, which affects five women for every man and predominates in people between 40 and 60 years of age."It is an autoimmune disease, as there is a breakdown of the body's defensive system and it is directly linked to some thyroid disease," explains Josep Maria Cubero, an endocrinologist at the Hospital de Sant Pau. It is what happens when the immune system makes a mistake and attacks not only external infectious agents, but also the muscle and fatty tissue of the eye socket. In fact, it is estimated that 40% of patients with Graves' disease—an autoimmune thyroiditis and the most common medical cause of bulging eyes—develop this eye condition, and some patients with Hashimoto's hypothyroidism also develop it, to a lesser extent.One in three patients suffers from a permanent or temporary disability

The disease causes inflammation of the orbit's musculature, a process that can last between a year and a half and three years if left untreated. Among the most common symptoms are eyelid retraction, difficulty closing the eyes completely, proptosis (bulging eyes), ocular redness, sensitivity to light, or the constant sensation of having sand in the eyes, among others. Alessia Fiorillo is a patient who suffers from thyroid eye disease and recalls that when she started having the first symptoms, she would look up and feel pain, as if her eyes were heavy. "I had a very strong headache above my left eye, light and the computer screen bothered me, and I had to wear sunglasses all day," details Fiorillo. These signs can be confused with other more common eye diseases, such as allergies or infections. In addition, according to Dr. Luna, "it is recommended to quit the smoking habit" for those affected, since smokers present a much higher risk of developing eye disorders related to the thyroid, in addition to showing greater resistance to treatment and a greater intensity of symptoms. There are also indications that very significant stress situations can favor the triggering of other immune eye disorders.In moderate and severe cases, more recurrent in men, if the disease is not detected in time and the proper procedure with the endocrinologist is not followed, patients can develop serious and chronic sequelae such as, for example, alterations in the lacrimal glands –and they may need artificial tears for life– or that the inflammation and the growing inflammation causes acute eye problems. For this reason, in one out of every three cases the patient ends up with temporary or permanent sequelae. Thus, it is important to recognize the disease as soon as possible and apply a multidisciplinary approach in which different professionals intervene. However, Dr. Cubero recommends that decision-making regarding the treatment of the same patient be simultaneous.The professional, social and emotional sphere

"Laborally and socially, all patients struggle with it," explains the ophthalmology specialist at Sant Pau Hospital: "There are patients who end up disfigured and must undergo surgical treatments." "Aesthetically you look very strange: your eyes bulge out and your gaze changes, as does your facial features," details patient Alessia Fiorillo, explaining that this affected her greatly psychologically, as it is difficult to recognize oneself. On one hand, there are symptoms linked to thyroid alteration and in the ocular sphere, as there may be pain, dryness in the eyes, or double vision that hinder daily actions such as looking at the computer, driving, or writing, which creates a feeling of lack of autonomy. "Many of these people take long-term sick leave, and those who work do so out of necessity or desire," adds Luna. On the other hand, in the social sphere, physical changes can cause emotional distress to the patient, leading them to avoid situations where they must meet with people. Many think: "you look disfigured and it's not you," she points out. In some cases, this situation can cause them to develop mental disorders, such as depression or anxiety. It is for this reason that, although its recognition has improved in recent years, one must "try to give more visibility to the disease among the majority of the population," states Cubero. And this is also confirmed by Fiorillo, who concludes that there is still a lot of misinformation surrounding this autoimmune disease and it must be given greater visibility.

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