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Thyroid Disease and the Eye
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Mark P. Hatton, MD
Peter A.D. Rubin, MD
Massachusetts Eye and Ear Infirmary, Harvard Medical School
October 15, 2002

Why are some thyroid diseases associated with eye problems?
Graves disease an autoimmune disease, is a disorder in which the body attacks itself. The body produces antibodies that bind to cells on the thyroid gland and stimulate them to make extra thyroid hormone. The antibodies can also stimulate cells in the orbit, the space around the eye, to cause them to grow and divide. While Graves disease is the most common thyroid condition associated with eye changes, other diseases such as Hashimotos's thyroiditis and toxic nodular goiter may affect the eye as well.

How is the eye affected?
When the cells in the orbit are stimulated, they divide and grow, and produce certain chemical substances that attract water. The immune system also creates an inflammatory response around the eye. As a result, early signs of thyroid eye disease may include swelling and redness.

Frequently, the muscles which move the eye become swollen. This can restrict them and LIMIT the ability to move the eye. This may result in double vision.

Often, the upper eyelid retracts. At the same time, the swelling around the eye may push the eye forward. Together, these can cause the cornea to become dry and irritated, and may result in infection or scarring if not treated.

Finally, the most serious possibility is damage to the optic nerve. The optic nerve carries electrical signals FROM the eye to the brain and runs through the orbit. When swelling occurs within the orbit, the optic nerve can become crushed, resulting in loss of vision. This can be permanent if not recognized and treated early.

How is thyroid eye disease detected?
Often, these changes are only detected by an ophthalmologist, so it is important that all patients with thyroid conditions be seen by an ophthalmologist on a regular basis.

How is thyroid eye disease treated?
Your ophthalmologist will work with your medical doctor to ensure that your high thyroid hormone levels are treated. Any patient with thyroid disorders should stop smoking, as smoking has been shown to increase the risk of thyroid eye disease.

The ways that thyroid disorders affect the eye vary greatly between patients FROM minor (dryness) to severe (vision loss FROM optic nerve damage).

Possible medical therapies may include:
- frequent lubrication of the eyes with artifical tears and ointments
- steroid medication to reduce the inflammation around the eye
- local radiation treatment to the orbit to stop the inflammatory cells FROM dividing.

Some patients may require surgery. In some cases, the bones around the eye can be expanded to produce more room for the swollen tissues. Occasionally, compression of the optic nerve may require surgery to provide more space for the nerve to function properly.

Some patients benefit FROM surgery to correct their double vision or the position of their eyelids.

The information and recommendations appearing on these pages are informational only and is not intended to be a basis for diagnosis, treatment or any other clinical application. For specific information concerning your personal medical condition, the DJO suggests that you consult your physician.