Thyroid Disease

People with hyperthyroidism (overactive thyroid glands) may experience changes around their eyes.  The most common abnormalities are prominent eyes, a staring expression, and infrequent blinking.

_Hyperthyroid Causes

In hyperthyroidism, abnormal antibodies attack the thyroid gland and cause it to become overactive. This overactivity causes the body to over produce thyroid hormones.

Abnormal antibodies may also cause swelling and inflammation of the soft fatty tissues around the eyes and the muscles that move the eyes and eyelids.  Inflammation can lead to protruding eyes, eyelids that may open too widely, or eyes that may not move together very well (causing double vision).

Chronic eye exposure from protrusion or lid retraction can lead to corneal scarring.  Double vision can be severe and disabling.  If the swelling is severe enough, the pressure in the eye socket can become extremely high and compress the optic nerve.  The patient might experience a progressive loss of vision, and possibly blindness if the condition is not treated promptly.

Symptoms of Hyperthyroidism

Eye problems can surface as soon as the patient’s thyroid gland becomes overactive. For some patients, the eye changes might develop before hyperthyroidism is detected; for others, symptoms might not develop until months or years later.

Both eyes usually are affected by problems, though they might not be affected to the same degree.

Common symptoms of eye problems associated with hyperthyroidism can include pressure around the eyes, ocular irritation, and tearing. Overexposure during the day and difficulty closing the eyes at night can lead to dryness or corneal injury. 

Inflammation of eye muscles might result in restricted eye movement, causing double vision.  If the muscles become too swollen, the enlarged muscles can compress the optic nerve and result in progressive visuals loss. 

Active inflammation usually subsides after several months.  Many patients will be left with some degree of protrusion, lid retraction, or double vision that might require additional treatment.

_Treatments

Many people can treat discomfort from thyroid eye disease with topical lubricants, wrap-around tinted glasses, or by sleeping with eye shields and with the head elevated. Oral cortisone or other anti-inflammatory medications can help reduce swelling when the patient has active inflammation with more severe symptoms.

Physicians sometimes use radiation to treat active inflammation. Surgery may be necessary to decompress the orbit if swelling behind the eye becomes severe.

Reconstructive eyelid or orbital surgery can improve the eye’s function and appearance. Surgical treatment is usually delayed until active inflammation subsides. The specific surgical technique used will depend on the type and severity of eye problems. One possible option is orbital decompression, when the surgeon removes part of the bony orbit and fat behind the eye to relieve pressure within the eye socket. Decompression can prevent damage to the optic nerve and allow the eyes to move back into a more normal position in the eye socket.

Surgery to reposition the muscles that control eye movement can improve double vision and eye misalignment.

Eyelid surgery to adjust the position of retracted lids can restore eyelid function and improve closure. Removal of excess fat from the eyelids can also improve their appearance.

Treatment Risks and Complications

Minor bruising or swelling may be expected after eye surgery and will likely go away in one to two weeks.  Bleeding and infection are potential risks with any surgery, but are very uncommon with these eye procedures.  Discuss any other potential risks with your surgeon.

Surgery might not completely eliminate all the consequences of thyroid eye disease. However, procedures to correct these conditions are generally successful in restoring function, comfort, and cosmetic appearance for the patient.