How Is Dry Eye Treated When You Have A Thyroid Condition
Treating your thyroid disorder wont be enough to manage your dry eye in most cases. Youll also need to take steps to keep your eyes moisturized.
Generally, dry eye caused by thyroid conditions will last for between 6 months and 2 years. However, you can take steps to manage it during this time. Treatment options include:
- Over-the-counter eye drops. You can use products such as artificial tears or lubricating eye drops to help manage your dry eye. However, its best to avoid products marked red eye relief since those can make dry eye worse.
- Prescription steroid eye drops. A medical professional, such as an ophthalmologist, can prescribe stronger steroid eye drops to help keep your eyes moist. These drops can also reduce any swelling or irritation. However, steroid eye drops are usually only safe to use for a short period of time.
- Prescription oral steroids. Oral steroid medications can sometimes help relieve dry eye and other eye health symptoms. They may be prescribed by the endocrinologist treating your thyroid condition.
A medical professional will likely also recommend at-home changes. Making these changes will reduce dryness and irritation in your eyes. These changes might include:
- quitting smoking, if you smoke
- wearing sunglasses and visors to protect your eyes
- avoiding overly hot and dry places
- resting your eyes often
Is My Thyroid Eye Disease Caused By Hashimotos Thyroiditis
The thyroid is a butterfly-shaped gland that sits at the front of your neck. This gland secretes hormones that affect a variety of body functions, including heart rate, body temperature, and metabolism.
Any issues with your thyroid gland and the production of thyroid hormones can affect many different areas of the body, including your eyes.
It’s estimated that 16 out of every 100,000 women and nearly 3 out of every 100,000 men¹ suffer from a condition called thyroid eye disease. This condition can occur in anyone, even those with a normally functioning thyroid, but it’s prevalent alongside certain thyroid disorders.
If you’ve been diagnosed with thyroid eye disease , understanding the link between your thyroid function and your eyes may help you discuss treatment options with your doctor. Learn more about thyroid eye disease, its causes, treatments, and the link to Hashimoto’s disease.
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Can Thyroid Issues Cause Eye Problems
The thyroid is a small butterfly-shaped gland located at the base of your neck. This endocrine gland is responsible for regulating your body’s energy use. It works with other glands and systems of the body to help determine what the body needs. For example, if you are cold or hot, this gland creates hormones that travel to the body’s cells to help regulate your body temperature. When you have issues with your thyroid, whether it is overactive or underactive , it can affect your body in different ways. As the thyroid gland regulates cellular metabolism in all the cells of your body, virtually every body system is affected when there is an issue with thyroid function.
How your thyroid and any problems it may have affects your vision is dependent on your diagnosis. Understanding your thyroid health and how it can affect your eyes and vision is the first step to ensuring your eye health remains intact while managing your thyroid condition.
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Other Types Of Treatment
If you develop double vision , you may be referred to a specialist health professional who manages problems with eye muscles . They may give you modified glasses that block off vision from one eye or put a special cover, called a prism, over one side to stop the diplopia.
Treatment using radiation may be used in some places on some people. The aim is to reduce the swelling in the eye. It is used alongside other forms of treatment.
A number of new treatments are being investigated.
Your doctors will also treat any abnormality of thyroid function with antithyroid medicines. This is usually with tablets but may also include radioactive iodine or, uncommonly, surgery to the thyroid gland. We know that good control of the thyroid function helps lessen the severity of thyroid eye disease. See the separate leaflet called Antithyroid Medicines.
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A clinical trial led by the University of Michigan Kellogg Eye Center offers hope for those with moderate to severe active TED. Patients had a significant reduction in the severity of symptoms after treatment with teprotumumab, a study drug the Food and Drug Administration designated a breakthrough therapy. Learn more about the results of this clinical trial.
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Thyroid Function And Eye Health
Your eye health can be compromised when your immune system mistakenly attacks its tissues. In Hashimoto’s, your immune system attacks your thyroid gland with TPOAb and TgAB .
In Graves’ disease, TSAb is primarily responsible for causing thyroid eye disease. People with Hashimoto’s who also have a thyroid-associated eye disease, have higher levels of TSAab. Although there is an apparent link between thyroid antibodies and eye health, the relationship is not entirely understood by science.
Common eye symptoms in thyroid dysfunction
Some people with Hashimoto’s complain of:
- Eyelid abnormalities, especially Upper Eyelid Retraction
- Periorbital swelling
- Loss of eyebrow and eyelash hairs
Unlike Graves’ thyroid eye disease, where symptoms are overt, eye-related disease symptoms in hypothyroidism are subtle except in severe cases.
Swelling may cause blurry vision due to pressure applied to the optic nerve. Similarly, hypothyroidism may cause dry eyes. A study comparing people with Hashimoto’s disease to people with a healthy thyroid found that those with Hashimoto’s are more likely to have dry eyes. This result is because the tear duct of the eye is a target organ of thyroid hormones. Therefore, thyroid deficiency may predispose people with hypothyroidism to dry eyes and eye surface changes.
Dry Blurry Eyes And Hypothyroidism
- Thyroid function and eye health
- Common eye symptoms in thyroid dysfunction
- Managing eye health with hypothyroidism
Eye problems are not commonly associated with hypothyroidism, an underactive thyroid. However, if you have Hashimoto’s thyroiditis, you may be at higher risk for eye disease. Hashimoto’s thyroiditis is an autoimmune condition that damages the thyroid gland. According to the American Thyroid Association, six-percent of people with Hashimoto’s have eye disease related to their thyroid functioning.
Eye conditions related to the thyroid are more common with Graves’ disease, an autoimmune condition causing hyperthyroidism than they are with Hashimoto’s. Indeed, one of the hallmark symptoms of Graves’ disease is bulging eyes. While thyroid-associated eye disease may get overlooked in people with Hashimoto’s, studies find that both hyper- and hypothyroid autoimmune processes can cause uncomfortable eye symptoms.
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Who Develops Thyroid Eye Disease
Thyroid eye disease is a rare condition. Each year it affects about 16 women and 3 men in every 100,000 people. Most of these people also have a problem with an overactive thyroid gland and have an underlying autoimmune condition. Occasionally, thyroid eye disease occurs when the thyroid gland appears to be working normally. However, people with an apparently normal thyroid gland at the time of thyroid eye disease have usually had abnormal thyroid function in the past or they go on to develop abnormal thyroid function in the future.
Thyroid eye disease generally occurs in middle age. Some people carry genes which make it more likely that they will develop thyroid eye disease. It is also more likely to develop if you smoke, particularly if you are a heavy smoker.
Who Is At Risk For Thyroid Eye Disease
Thyroid eye disease is most commonly associated with Graves disease. It can also occur with normal thyroid hormone levels or low levels of thyroid hormones .
Other risk factors for thyroid eye disease include:
- Age: Usually affects middle-age adults but can occur at any age
- Gender: Females are affected more than males
- Family history of thyroid eye disease
- Smoking: Smoking increases the risk of thyroid eye disease by 78 times, causes thyroid eye disease to have a longer active phase, and it reduces the effectiveness of treatments
- Radioactive iodine therapy: Radioactive iodine has been used to treat hyperthyroidism and Graves disease. This treatment should be used with caution in people with active thyroid eye disease as it may worsen the condition unless steroids are given at the same time
- Low blood levels of selenium, a dietary mineral.
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How To Manage Your Eye Health
Scheduling annual eye exams to monitor your vision is always recommended, regardless of your thyroid. While you may experience things like blurry or double vision with hyperthyroidism, it is essential to check with your ophthalmologist to find the root cause of any vision issues you may have. If you find yourself squinting or getting chronic headaches, you could very easily need a new prescription. Addressing your vision troubles is nothing to stress about, though. Buying prescription glasses and frames online can be done in minutes. Like many other parts of your body, your eyes can change over time, and without corrective surgery, a stronger prescription will be necessary.
Effect Of Thyroid Eye Disease On Quality Of Life And Mental Health
Patient QOL was markedly impaired by TED at the time of survey, as indicated by an overall GO-QOL score of 60.5±21.8, an appearance sub-score of 62.3±25.1, and a visual function sub-score of 58.6±24.0. Of note, 70% of patients had an overall GO-QOL score< 75, and 33% of patients had an overall score of50. Additionally, 42% of patients reported having anxiety and/or depression , more than double the prevalence of mental health issues in the general US adult population . Further, patients sought medical care often for their TED, with an average of 19.7±31.7 TED-related doctor visits/patient reported in the year prior to survey. Endocrinologists and ophthalmologists were most often seen, followed by optometrists and primary care physicians. Fourteen percent of patients reported being disabled/unemployed at the time of survey.
Factors that Influenced Quality of Life
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How Does Thyroid Eye Disease Affect Mental Health
TED can cause eye pain, double vision, loss of vision, and changes to your appearance which may impact your quality of life. The impacts of TED can lead you to experience to depression, anxiety, loss of independence, and reduced self-confidence. You may have a decreased desire to socialize with others, have trouble with productivity at school or work, and stop doing activities you once enjoyed.
To help support your mental health as you deal with TED:
- Talk to your doctor: Talk to your doctor about any changes to your emotional well-being. Ask questions on how TED will affect your daily life and work.
- Seek support: Seek out support groups of others who are going through TED. The Graves Disease and Thyroid Foundation offers support groups for people with Graves disease, thyroid eye disease, and other thyroid conditions. These groups can help you learn about your condition, share your experience, and find support.
- Connect with others: Stay connected friends and family to keep you from feeling isolated.
- Take time to enjoy life: Take part in activities or hobbies that make you happy.
- Exercise: Exercise can help symptoms of depression or anxiety and make you feel better. Talk to your health care professional to determine what exercise routine may work best for you, especially if you have changes to your vision due to TED.
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Are There Any Complications From Thyroid Eye Disease
Most people do not develop permanent complications. However, where treatment is delayed or where the thyroid eye disease has been severe, there can be lasting effects. They are also more likely in older people, in those who smoke and in people with diabetes. Possible complications include:
Complications from the disease
- Damage to the clear window of the eye .
- Permanent squint or double vision .
- Damage to the nerve of the eye, resulting in poor vision or colour appreciation.
- Altered appearance .
Complications from treatment
- Side-effects from the immunosuppressive medicines.
- Side-effects from the surgery:
- New double vision .
- Loss of vision .
- There are some other very rare complications that your surgeon will talk you through.
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Who Gets Thyroid Eye Disease
People with Graves’ disease are at higher risk for developing thyroid eye disease. By some estimates, up to 50% of people with Graves’ disease also have symptoms associated with thyroid eye disease.
The condition, however, is sometimes seen in people with no other evidence of thyroid dysfunction, and occasionally in patients who have Hashimoto’s disease. Most thyroid patients, however, will not develop thyroid eye disease, and if so, only mildly. Smoking is associated with a worsening of symptoms.
When To See A Doctor About Thyroid Eye Disease
If you have been diagnosed with a thyroid disorder such as Hashimoto’s disease or Graves’ disease, your primary care physician or endocrinologist should monitor you for thyroid eye disease as well.
Let your doctor know if you have any new symptoms, such as dry eyes, double vision, or swollen eyelids. The earlier you start treatment, the better the outcomes for TED.
If you don’t have a diagnosed thyroid condition but are experiencing some of the symptoms of thyroid eye disease, make an appointment with your primary care provider. This condition shares many symptoms with common medical conditions such as hayfever and conjunctivitis. Your doctor can order tests to determine the underlying medical cause of your symptoms.
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Treatment Of Thyroid Eye Disease
For a mild case, use lubricating eye drops and artificial tears a few times during the day. Avoid wind and bright light.
If you have severe symptoms, your healthcare provider may prescribe corticosteroids such as prednisone to reduce swelling. In a very small percentage of patients, orbital decompression surgery may be recommended.
This procedure removes the bone between the eye socket and the air sinus behind it so your eye has more room. This can improve your vision but there is a risk of double vision.
Double vision can also occur when scar tissue from the ophthalmopathy makes an eye muscle too short. Eye muscle surgery can be used to attach the muscle at a point where it will again be the correct length to provide single vision. However, more than one surgery may be needed to be successful.
How Can I Take Care Of Myself
To relieve eye pain and other symptoms at home, you can:
- Apply cool compresses. Hold a wet washcloth to your eyes to moisten them and soothe soreness.
- Use lubricating eyedrops. Artificial tears can ease some of the dryness and scratchy feeling in your eyes. You might also use a lubricating gel or ointment before bed to keep your corneas from drying out if your eyes don’t fully close.
- Wear sunglasses. Thyroid eye disease can make your eyes more sensitive. Wearing sunglasses will protect them from ultraviolet light and wind.
- Sleep with your head raised. Keeping your head higher than your body can reduce swelling in your eyes.
- Cover your eyes. Use eye covers or tape your eyes closed to keep them from drying out if your eyelids don’t fully close.
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What Is Thyroid Eye Disease
Thyroid eye disease , sometimes called Graves ophthalmopathy or Graves Eye Disease, is an autoimmune disease in which the immune system causes inflammation and swelling and stimulates the production of muscle tissue and fat behind the eye. The overactive thyroid gland is usually caused by Graves disease. Up to one-half of people with Graves disease develop thyroid eye disease. In some people, thyroid eye disease can occur with normal levels of thyroid hormones or low levels of thyroid hormones . Thyroid eye disease may occur in patients who already know they have thyroid disease, or it may be the first sign of Graves disease. While TED often occurs in people living with hyperthyroidism or Graves disease, it is a distinct disease and treating hyperthyroidism may not resolve the eye symptoms and signs.
Parts of the Eye
Symptoms Of Thyroid Eye Disease
Early symptoms of thyroid eye disease may include:
- Itching, dry eyes, and difficulty wearing contact lenses
- Excessively watery eyes
- Red or bloodshot eyes
- Swelling of the orbital tissues which causes the eye to be pushed forward referred to as exophthalmos, which can make people with thyroid eye disease appear to have a wide-eyed or bulging, protuberant stare.
- Pain when moving the eyes up, down, or sideways
- Light sensitivity
Thyroid eye disease can cause inflammation and swelling that may affect the eyes as well as the muscles and other tissues around the eyes. As the disease progresses, symptoms can include the following:
- Increased sensitivity to light
- Impaired vision
- Difficulty moving or closing the eyes
Thyroid eye disease is known to go through varying degrees of severity and can go into periods of remission. It often lasts six months to two years. When it has been inactive for a period of around a half a year, it’s less likely to recur.
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How Is Thyroid Eye Disease Diagnosed
Thyroid eye disease diagnosis differs based on whether you were pre-diagnosed with thyroid dysfunction or not. In people who already have thyroid dysfunction, the only consultation is with an ophthalmologist who will look at your symptoms and give you a clear diagnosis.
However, if you have never been diagnosed with any hormonal imbalance, your ophthalmologist will suggest you consult with an endocrinologist to check your hormone levels first .
After the blood exams and symptoms give a picture of the expected diagnosis, an MRI or a CT scan may be sometimes suggested to confirm the diagnosis just to be more clear.