Thyroid Eye Disease

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KEY POINTS

• Thyroid eye disease is swelling of the muscles, fat, and soft tissue around and behind your eye, which can cause your eye to be pushed forward.
• Treatment may include artificial tears, medicines, radiation, surgery, or treating high thyroid hormone levels.

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What is thyroid eye disease?

Thyroid eye disease is swelling of the muscles, fat, and soft tissue around and behind your eye, which can cause your eye to be pushed forward.

What is the cause?

The exact cause of thyroid eye disease is not known. It is probably caused by your own immune system attacking the tissues around your eye.

It is more common if your body makes too much thyroid hormone, a problem called hyperthyroidism. Thyroid eye disease is more common in people who have a type of hyperthyroidism called Graves' disease. Although thyroid eye disease is most common in people who have high thyroid hormone levels, lowering your thyroid hormone levels does not cure the disease. People who have normal thyroid levels can also get thyroid eye disease.

You are more likely to develop thyroid eye disease if you smoke.

What are the symptoms?

Symptoms may include:

• Eyes that bulge forward more than usual from the sockets, and eyelids that do not completely close over the eye. The white of your eye may show even when you try to close your eyes. Your eyes may look different from each other.
• Dry, red eyes that feel scratchy. The dryness may happen because your eyelids are not covering enough of your eye or they do not close all the way. Your eyes may dry out while you sleep, which may lead to eye damage.
• Tearing, which is your body's response to dry eyes
• Double vision if the muscles that control eye movements are affected
• Swelling and irritation of the eye tissues
• Decreased vision

How is it diagnosed?

Your eye care provider will ask about your symptoms and medical history and do exams and tests such as:

• An exam using a microscope with a light attached, called a slit lamp, to look closely at the back front and back of your eye
• An exam using drops to enlarge, or dilate, your pupils and a light to look into the back of your eyes
• A test of the way your pupils react to light
• CT scan, which uses X-rays and a computer to show detailed pictures of your eye socket
• An ultrasound, which uses sound waves to show pictures of the eye and eye muscles
• Blood tests to check thyroid hormone levels

How is it treated?

Artificial tears or ointment at night can help dry eyes. Sometimes steroid drugs or low doses of radiation are used to reduce the swelling and irritation around the eye. If you have double vision, special glasses may help.

After the swelling and irritation are treated, surgery may be done to help your appearance or improve your vision.

If you have hyperthyroidism, treating your high thyroid hormone levels is an important part of your overall health. Your provider may prescribe medicine to control your thyroid hormone levels. You may need regular blood tests to check your hormone levels and make sure they are in good control.

If you smoke, quitting smoking can help slow disease progression.

How can I take care of myself?

Follow the full course of treatment your healthcare provider prescribes. Ask your healthcare provider:

• How and when you will get your test results
• How long it will take to recover
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

How can I help prevent thyroid eye disease?

Usually thyroid eye disease cannot be prevented. However, serious problems with your eyes and blindness can be prevented by early diagnosis and treatment. Have regular checkups. If you smoke, quit. Contact your healthcare provider if you develop any symptoms that concern you.