Dry, irritated eyes are a common complaint, and usually caused by allergies, smoke or other environmental factors. Thyroid eye disease, however, is an autoimmune condition that also can cause these symptoms.
Thyroid disease occurs when your immune system attacks the tissue around your thyroid gland in your neck. In cases of thyroid eye disease, the body attacks not just the thyroid but also the tissue around the eyes.
Thyroid eye disease symptoms can include dry, watery, red or bulging eyes, as well as discomfort and double vision. Most cases are mild and may cause eye irritation or swelling of the upper and lower eyelids. The eyelids may not close completely. In more advanced cases, the muscles, nerves and fat around the eyeball can become inflamed.
“If the tissue behind the eye gets inflamed, then the eye can start to pop out,” explains Dr. Ozgur. “The optic nerve connects the eyeball to the brain, and if that tissue gets inflamed or if the tissue around it gets swollen, the nerve can get compromised, leading to blurry vision.”
The exact cause of thyroid eye disease, like thyroid disease itself, is unknown. Patients with a history of thyroid disease are most at risk, but it can occur in patients who have never been diagnosed with the disease. The risk of thyroid eye disease also may be higher if a family member has it.
To diagnose thyroid eye disease, an eye doctor will take a medical history, perform a clinical examination, and may order blood tests and imaging exams, such as a CT scan or MRI.
Without treatment, the inflammatory changes caused by thyroid eye disease can progress and worsen to the point where patients might not be able to close their eyes. They may experience bleeding due to sores forming in the eyes. If inflammation severely damages the optic nerve, they could lose their vision.
Treatment depends on how advanced the disease is. In the mildest cases, it’s treated with lubricating drops. Medications may be used to treat general inflammation; newer anti-inflammatory medications are on the horizon that directly target the eye tissue.
As symptoms become more advanced, surgical treatments to address the specific issues may be necessary.
“We have a multidisciplinary approach here at Scripps. We have our oculoplastic surgeons, we also have our neuro-ophthalmologists, and we have our strabismus specialists,” says Dr. Ozgur. “So whatever tissue is being affected by the disease, we have specific tools to address those issues.”
Surgical options may include decompression surgery to remove some of the bone around the eye, which creates more space for the eye tissue and helps relieve the pressure caused by inflammation. Eyelid surgery may be performed to allow the lids to fully close and better protect the eye. Strabismus surgery realigns the muscles around the eye to prevent double vision.
In addition, lifestyle changes, such as quitting smoking and eating an anti-inflammatory diet can help with treatment.
If you experience symptoms of thyroid eye disease, especially if you have thyroid disease, make an appointment with an eye doctor to have them checked out.
“Some of these more mild issues like dryness, tearing and redness can have a lot of overlapping causes,” says Dr. Ozgur. “But if these symptoms are not improving with typical treatment like lubricating drops, it’s important to be evaluated for thyroid eye disease to make sure we catch it as early as possible.”