Thyroid eye disease may occur in patients who already know they have thyroid disease, or sometimes it’s the first problem that brings the person to the doctor’s office. The symptoms that occur in thyroid eye disease include dry eyes, watery eyes, red eyes, bulging eyes, a “stare,” double vision, difficulty closing the eyes, and problems with vision.
Research suggests that the cause of thyroid disease and thyroid eye disease is an autoimmune disorder. An imbalance or recognition problem occurs in the immune system. The immune system normally protects our bodies from foreign invaders such as bacteria or viruses, and also protects us from abnormal cells such as cancer. In thyroid eye disease, the immune system sets off an abnormal reaction to the muscles and fatty tissue around the eyes. Although many patients with thyroid eye disease will have abnormal blood tests for thyroid hormone levels, there are some people who get the eye symptoms even though the hormone levels are normal.
If you are newly diagnosed with thyroid eye disease, your eye doctor may ask you to see an endocrinologist or internist to check your hormone levels. The doctor may recommend ablation of the overactive thyroid gland or taking oral thyroid medication when the gland is underactive. While it is important that hormone levels are kept as close to normal as possible, this will not guarantee that a patient will not develop thyroid eye disease.
Eye Symptoms and Treatment
Thyroid eye disease can affect many different parts of the eye and surrounding tissues. Inflamed lacrimal glands may cause wet eyes or dry eyes, and these can both happen in the same patient at different times. Lubrication with eyedrops or ointment can help to soothe this irritation. The abnormal immune reaction causes swelling in the tissues of the eyelids and orbit which can make the eyelids look puffy or as if the person has “baggy” eyelids. This can also create a sensation of pressure around the eyes. The swelling can be surgically altered to bring the lids back to a more normal shape.
The muscles in the eyelids tighten and pull the upper lid up and the lower lid down. This creates a startled look with too much of the whites of the eyes showing. This also can be surgically improved. The muscles which control movement of the eyes may be increased in size by the swelling. This can create problems with double vision and focusing. Prism glasses may be helpful, and this can also be improved by surgically moving the eye muscles.
These symptoms of redness, irritation, pressure and double vision are treated with lubrication, anti-inflammatory medications and prisms for the double vision, and will require some time to stabilize before your doctor will recommend surgical intervention. Typically, the active or inflammatory stage of thyroid eye disease lasts one to three years. During this time, your doctor will avoid surgically treating these symptoms because the tissues are constantly changing, and the results will not be stable. However, there are some problems that are dangerous to your vision, and these require more immediate treatment.
Because the eye is pushed forward, and because the eyelids are pulled open by the muscles, you may have difficulty closing your eyelids. This can lead to a corneal ulcer, which causes scarring and permanent loss of the vision. Immediate treatment is necessary. The corneal ulcer would cause redness of the eye, pain and usually decrease in vision. You should seek immediate attention from your doctor for these problems. A second danger to vision occurs when swollen tissues compress the optic nerve. The optic nerve functions as an extension cord between the eye and the brain to carry the message of vision. When the nerve is compressed, color vision is abnormal, lights may seem dimmer than usual, and the sharpness of the vision decreases. These changes may be reversed with treatment, but could progress to permanent loss of vision. Tell your doctor immediately if you are experiencing any of these symptoms.
The treatment options for vision-threatening problems in thyroid eye disease include corticosteroids or other anti-inflammatory medications, radiation and surgery. A combination of these may be necessary to protect vision. Most people with thyroid eye disease do not get corneal ulcers or optic neuropathy, but it is important to understand the symptoms so you know when to seek help.
Examination
To assess your vision and the changes in the tissues around your eyes, there are several tests you can expect your eye doctor to perform. These include vision testing, color vision testing, visual fields, eyelid measurements, eye pressure readings, checking the optic nerves, and sometimes photographs.
If you have thyroid disease and suspect that you may have thyroid eye disease, your doctor may recommend that you see an eye doctor. If during a comprehensive eye examination, a consultation will be scheduled with an Ophthalmic Plastic and Reconstructive Specialist who have a special interest and training in thyroid eye disease. They will be able to evaluate your symptoms, recommend a course of treatment, discuss surgical options to bring your eyelids back to their normal appearance, and help you watch for any problems with decreased vision.
