How Thyroid Disease Affects the Eyes

By Barb Hicks

Many body functioning processes are affected by the thyroid gland including metabolism. This endocrine gland is butterfly shaped and manufactures and secretes Thyroxin or T4 in response to TSH being released from the pituitary gland. The thyroid gland responds to this by secreting the necessary amount of thyroid hormone into the blood stream.

If there is not enough T4 in the system, it is classified as hypothyroidism. On the other hand, if there is too much thyroid hormone it is called hyperthyroidism. Both conditions are autoimmune diseases denoting thyroid hormone imbalance that can show outward signs of its existence, such as thyroid eye disease.

What Is Thyroid Eye Disease?

Most often, TED is found in those with hyperactive thyroid also referred to as overactive thyroid or hyperthyroidism. However, it has presented itself in those with normal levels of thyroid hormone as well as those lacking sufficient amounts of thyroid hormone also known as hypothryoidism.

Another name for this disease is exophthalmia, as well as orbitapathy and ophthalmopathy. The condition can progress to the point that it prevents the eyelids from closing completely, leading to dryness and irritation of the eyeball. Many times, it may be necessary to tape the eyelids shut during sleep to avoid further eye damage.

The effects of thyroid disease have an impact on the eye muscles that become swollen, pushing the eyeball forward. Other causes may include infection of the eye, enlarged blood vessels, and tumors. The bulging may occur in one or both eyes. Approximately 80 percent of all patients with TED have Graves' disease due to hyperactive thyroid. Other cases involve Hashimoto's thyroiditis Hashitoxicosis, or atrophic thyroiditis.

Signs and Symptoms of TED:

Proptosis (exophthalmos or bulging) Conjunctivitis (inflammation of the eye) Dryness Eyelid retraction Eyelid lag Twitching Redness Itching Double vision Retrobulbar pain Pain on or behind the eye Chemosis (edema or swelling) Swelling Blurriness Eye muscle paralysis Corneal irritation leading to corneal inflammation Difficulty moving the eyes Foreign body sensation Formation of scar tissue Lacrimation (tearing) Sensitivity to light Upper eyelid droop Staring Visual impairment

Surgical Treatment:

Orbital decompression surgery: This specialized surgery focuses on removing the bone between the cavity surrounding the eye or the orbit and the surrounding sinuses. The result is additional space for swelling behind the eyes while decreasing protrusion and pressure on the optic nerve.

Eye muscle surgery: The main goal of this procedure is to correct and realign the muscles of the eye. Upon successful completion, the single vision of the straight-ahead and down gaze should be significantly improved.

Eyelid surgery: In Graves' ophthalmopathy the eyelids open more widely. The surgery on eyelids is performed to correct this to give a look that is as close to normal as possible. - 29957

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