How can thyroid conditions affect the eyes Thyroid ophthalmopathy (or Graves’ ophthalmopathy) is an autoimmune, inflammatory disease of the eyes and the tissues around them. It is usually seen in hyperthyroid patients. However, it is also sometimes seen in patients with Hashimoto’s thyroiditis, which is the most common cause of hypothyroidism.
“The thyroid is a gland in the front of the neck that produces hormones necessary to regulate metabolism and many other functions in the body. Thyroid ophthalmopathy develops when the immune system causes damage to the thyroid gland. These lesions are more common when the thyroid is overactive.
Sometimes, however, they are also observed when it is underfunctioning or very rarely when it produces normal levels of thyroid hormones. In all cases, the immune system attacks the eye muscles and tissues around the eyes,” says Dr. Anastasios-I. Kanellopoulos, MD, Ophthalmologist, founder and scientific director of the LaserVision Ophthalmology Institute, Professor of Ophthalmology at New York University.
Thyroid diseases are very common. More than 12% of adults will develop a disorder in the gland at some point in their lives. Female patients are five to eight times more numerous than males, especially after pregnancy and menopause.
However, although thyroid diseases are so common, almost 60% of patients do not know that they suffer from them because they do not do preventive tests.
Hyperthyroidism is one of the main thyroid diseases. It is estimated to affect 0.5% to 2% of the population. The most common cause of hyperthyroidism is Graves’ disease. Every woman has a 3% chance of developing it and every man 0.5%. The disease manifests itself most often between the ages of 30 and 60.
“Nearly 40% of Graves’ disease sufferers develop thyroid eye disease either before, during, or after their thyroid disease diagnosis. The average age of development of eye disease is 40-45 years. In most cases the eye disease is mild. However, 5-6% of patients manifest mild to severe thyroid eye disease”, emphasizes Mr. Kanellopoulos.
The chances of developing an eye problem due to thyroid disease are significantly affected by history of smoking. If the patient is a non-smoker or ex-smoker at the time Graves’ disease is diagnosed, they have less than a one in 10 chance of developing thyroid eye disease. But if he smokes a little or moderately, his chances double. And if he is a heavy smoker (a pack of cigarettes or more a day), he is eight times more likely than non-smokers to develop it.
Thyroid eye disease is also more likely in those who have a family history of the same eye problem, as well as those who have low levels of selenium in their body.
Thyroid ophthalmopathy manifests itself with a variety of symptoms, which may develop with flare-ups and remissions. One of the most common is eyelid twitching. According to her, the upper eyelid is “pulled” upwards and the white part of the eye becomes more visible (as if the eye has “rolled”) when the patient looks at something straight ahead.
Also, because thyroid eye disease causes edema (swelling) in the muscles in and around the eye, it can push the eyeball forward. The consequence is the well-known exophthalmos (or prolapse of the eyes from the eye sockets).
Thyroid eye disease can also cause changes in vision, such as diplopia; (the sufferer sees double images, especially when looking to the side, such as when looking at the side mirror in a car). Edema can also increase the pressure inside the eye, causing damage to the optic nerve and reduced vision.
Sufferers may also develop “bags” around the eyes them, because of the swelling in their eyelids. It is also very common dry eye, because their eyes are more exposed to wind and dust. This dry eye is often accompanied by blurred vision and increased tear production (lacrimation).
Intense sensitivity to light, redness of the eyelids and eyes, pain in or behind the eye (especially when the sufferer looks up, down or sideways) and difficulty moving the eye can also occur.
“If a patient has puffy eyelids and puffy skin around and under the eyes, and at the same time has hypothyroidism, then they probably don’t have thyroid eye disease. He just needs treatment for his hypothyroidism and the swelling in his eyes will go away,” explains the professor.
OR Treatment of thyroid eye disease depends on its severity. Patients may be offered conservative and/or invasive treatments. Conservatives include artificial tears or lubricating ointments (to soothe dry eyes), sunglasses (for sensitivity to light), cold packs (to relieve swelling and irritation), and smoking cessation (worsens eye symptoms). Prisms may also be prescribed for the patient’s glasses to correct diplopia. These prisms can be temporarily or permanently attached to the crystals.
If the condition does not improve with these measures, if it worsens, or if the eye disease is already moderate to severe, medication may be needed. It can, e.g. give patients steroid medication to reduce swelling of the eyelids. Or to have an intravenous infusion of special medicine that reduce symptoms and the need for surgery.
“In severe cases, such as exophthalmos and eyelid retraction, surgical treatment may be needed to reposition the eyelids or eye muscles, or to remove scar tissue or even part of the eye socket. The operation can correct the appearance of the eyes, relieve dry eyes, improve vision and relieve pressure on the optic nerve, preventing vision loss. Early diagnosis and treatment can increase the success of the patient’s treatment”, concludes Mr. Kanellopoulos.