The Optometrist’s Role: Lifestyle and Nutrition for Supportive Care in Thyroid Eye Disease (TED) By Nifemi Dahunsi

 

 

Thyroid Eye Disease (TED), or Graves' Ophthalmopathy, is an autoimmune orbitopathy that inflames and remodels orbital tissues, often leading to visually impactful conditions like proptosis, diplopia, and severe dry eye. While endocrinologists and ophthalmologists manage the primary medical and surgical treatment, optometrists are essential partners in care, frequently serving as the first point of diagnosis and providing long-term supportive management. The critical role of the optometrist involves counseling on key lifestyle and nutritional modifications—strategies backed by peer-reviewed evidence—to mitigate symptoms, reduce inflammation, and optimize patient response to conventional therapy.

The most impactful intervention an optometrist can counsel a TED patient on is smoking cessation [1]. This habit is unequivocally the most significant modifiable risk factor, drastically increasing the risk and severity of TED and actively diminishing the efficacy of medical treatments, including advanced biologics [5]. By linking smoking directly to poor cosmetic and functional outcomes, such as reduced improvement in proptosis, the optometrist reinforces the urgency of quitting, transforming this general health advice into a therapeutic imperative.

Beyond smoking, simple lifestyle adjustments directly address the mechanical and inflammatory challenges faced by TED patients. Due to conditions like lid retraction and proptosis, exposure keratopathy and dry eye are pervasive, necessitating guidance on consistent use of non-preserved artificial tears and lubricating gels [6]. Protective measures, such as wearing wraparound sunglasses, are crucial to shield the exposed ocular surface from environmental irritants and dust. Furthermore, recommending that patients sleep with their heads slightly elevated can help reduce the uncomfortable morning periorbital edema and congestion by facilitating orbital fluid drainage [2, 5].

The nutritional approach to TED is centered on an anti-inflammatory framework. Key to this strategy is optimizing micronutrient status. Selenium, an essential trace element with strong antioxidant properties, has demonstrated efficacy as an adjunct therapy. A landmark randomized trial found that supplementation in patients with mild TED led to improved quality of life and slowed disease progression [2]. While optometrists do not prescribe supplements, awareness of this evidence allows for informed referral and discussion with the patient's endocrinologist. Similarly, correcting deficiencies in Vitamin D is relevant, as low levels have been statistically associated with an increased risk of developing Graves’ ophthalmopathy [3].

Dietary counseling should promote the regular intake of Omega-3 fatty acids (from sources like fatty fish) for their systemic anti-inflammatory benefits, which may help modulate tissue swelling [2]. A diet rich in antioxidants from colorful fruits and vegetables is vital for supporting ocular tissue health. Finally, advising patients to limit high-sodium foods is a practical tip to help minimize overall fluid retention and directly alleviate the bothersome eyelid swelling that patients frequently report [5].

In conclusion, the optometrist’s role extends beyond visual correction and managing immediate ocular pathology. By incorporating evidence-based counseling on smoking cessation, promoting targeted nutritional support (particularly selenium and an anti-inflammatory diet), and providing guidance on essential supportive habits, the optometrist acts as a critical liaison. This comprehensive approach is key to empowering the patient, reducing disease burden, and ultimately optimizing the long-term visual and quality of life outcomes for individuals managing Thyroid Eye Disease.

References

1.     Bartalena, L., et al. (2013). The 2013 European Thyroid Association/European Group on Graves’ Orbitopathy (EUGOGO) Guidelines for the Management of Graves’ Orbitopathy. European Thyroid Journal, 2(1), 9–26.

2.     Marcocci, C., et al. (2011). Selenium and the course of mild Graves' ophthalmopathy. The New England Journal of Medicine, 364(20), 1920–1931.

3.     Ma, L., et al. (2017). Low serum 25-hydroxyvitamin D levels are associated with increased risk of Graves’ ophthalmopathy in patients with Graves’ disease: a meta-analysis. International Journal of Environmental Research and Public Health, 14(3), 324.

4.     Vashdi, I., & Gur, Z. (2022). [Lifestyle adjustment as therapeutic tool in Thyroid Eye Disease]. Harefuah, 161(4), 223–227.

5.     Rochman, C. M., et al. (2023). Effects of Smoking on Outcomes of Thyroid Eye Disease Treated with Teprotumumab: A Retrospective Cohort Study. Kansas Journal of Medicine, 16(1), 62–64.

6.     Perros, P., et al. (2018). Management of thyroid eye disease: a Consensus Statement by the American Thyroid Association and the European Thyroid Association. Nature Reviews Endocrinology, 14(12), 733–747.