Bulging eyes, excessive tearing and pain, dryness, redness and discomfort in the eyes could signal thyroid disease.
Thyroid eye disease (TED) is an eye condition related to thyroid disease. Thyroid hormones produced by the thyroid gland in the neck regulate metabolism in the body. People with excessive thyroid hormones (hyperthyroidism) can develop eye diseases.
Thyroid eye disease is more common
in women and although often
associated with hyperthyroidism, may
occur in patients with normal or low
thyroid hormone levels. Although the
exact cause is unclear, what is known
is that the body produces antibodies
against its own tissues in the orbit.
This sets off a series of biochemical
events that leads to swelling of the
orbital soft tissues, specifi cally the eye
muscles and orbital fat.
They may have any of the following symptoms :
The most signifi cant, but rare, complication of thyroid disease is loss of vision due to compression of the optic nerve by swollen tissues around the eye. Swelling of the orbital tissues can cause the eye to bulge outwards and limit the eye’s ability to close the eyelids, exposing the front surface of the eye and causing irritation and damage to the cornea. Patients can also suff er from double vision due to marked swelling and stiff ening of eye muscles.
Patients with thyroid eye disease may complain of the following :
Natural Course. It is common for
thyroid eye disease to fluctuate within the first one to two years of
the disease. Beyond this time, the
disease tends to stabilise. Medical
therapy (immunosuppression and
radiotherapy) are more effective
in the active phase of the disease.
Surgical treatment is usually reserved
for patients in the inactive phase. It
is important for you to be seen and
treated by a doctor for the underlying
thyroid disease throughout this
period. Although thyroid eye disease
tends to improve with good thyroid
hormone control, this is not always
the case, and consultation with an eye
doctor is necessary.
Local Therapy. Tear substitutes and
lubricants help to protect the surface
of the eye from drying. Sleeping
on extra pillows helps to reduce
swelling around the eyes. Double
vision can be troublesome if it affects
straightforward and down-looking
positions (as in reading). Special
lenses called prisms may relieve this.
Immunosuppression. Your eye
doctor will advise you on the
treatment for thyroid disease.
Steroids are used in selected cases.
Taken orally, steroids can cause
many side-effects when used over
a long period of time. These include
weight gain, gastric symptoms and
bleeding, aggravation of diabetes and
high blood pressure and decreased
resistance to infection. Where
possible, intravenous steroids are
given instead. Steroid therapy may
also be combined with the use of other
Radiation. Radiation is an eff ective
way of reducing the swelling of
tissue around the eye and relieving
compression of the optic nerve. The
therapeutic dose used is low and is
usually not associated with significant
When vision is threatened, early lid
or orbital surgery may be necessary.
Otherwise surgery is usually
reserved for inactive disease. Surgical
rehabilitation is usually staged with
orbital decompression surgery to reduce
proptosis, followed by squint and eyelid
surgeries to eliminate diplopia (double
vision) and exposure respectively.
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