Whether lowering intraocular pressure is needed for thyroid associated ophthalmopathy with intraocular hypertension

Abstract

Patients with thyroid associated ophthalmopathy often have elevated intraocular pressure. Patients and doctors are often confused about whether intraocular hypertension in thyroid associated ophthalmopathy needs to be lowered. There are several theories on the possible causes of this kind of increased intraocular pressure: restriction and compression of the globe by fibrotic and enlarged rectus muscles, increased episcleral venous pressure resulting from orbital congestion and venous outflow obstruction, and increased resistance to trabecular outflow. In addition, the patient's eye position and the device for measuring intraocular pressure also have great impacts on the accuracy of intraocular pressure measurement. At the same time, there are very few patients with thyroid associated ophthalmopathy combined with primary glaucoma. Therefore, whether patients with elevated intraocular pressure need to be treated depends on the specific clinical manifestations of the thyroid associated ophthalmopathy. Intraocular pressure of most patients can be lowered by active treatment for thyroid associated ophthalmopathy; antiglaucoma medical therapy may be necessary for patients whose intraocular pressure cannot be lowered; only very few cases of glaucoma require antiglaucoma drugs or surgery. (Chin J Ophthalmol, 2019, 55:811-813).