Thyroid eye disease is a spectrum of effects caused on the eyes by an imbalance of the thyroid hormone or Thyroxine in the body. Thyroxine is produced by the thyroid gland, situated in the neck’s front part. It is essential for maintaining the body’s metabolic rate and plays a role in heart health and digestion. It is also vital for brain function and maintaining our bones’ strength. 

Thyroid eye disease may be caused by increased or decreased Thyroxine levels over time. An increase may be caused by overactivity, inflammation of the gland, or a benign tumor. A decrease may be due to inadequate iodine intake, autoimmune disease, or certain medications. 

Eye involvement may sometimes be the first thyroid eye disease symptom. In this disease, the eyelids, eye muscles, the tear gland, and the fatty tissue surrounding the eye become swollen and more prominent in size. The eyes may appear to bulge outwards, giving the appearance of ‘staring’ or ‘angry’ eyes due to exposure of the whites of the eye.

Redness and swelling of the transparent outer surface of the eye are also common. Difficulty closing the eye can cause increased irritation on exposure to wind and sunlight, resulting in watering and redness. Continued exposure can lead to dryness and corneal infection or ‘ulcer’, which can cause eye scarring. The upper eyelid may appear to be retracted and tight.

Thickening of the muscles of the eye can lead to double vision. In a few cases, swelling of the eye tissues may lead to compression of the optic nerve that supplies the vision, resulting in vision loss and potentially blindness. Most people with thyroid eye disease do not experience vision problems, but it is vital to recognize symptoms to seek timely help.    

If you or someone around you is suffering from such symptoms, it is essential to seek the advice of an ophthalmologist near you. They may refer you to an endocrinologist who will identify the hormone imbalance and correct it with medications. At the eye clinic, tests for vision and eye pressure, color vision, retina examination, and visual fields, along with eye measurements and photos for documentation, may be carried out. 

Thyroid eye disease treatment is based on the severity of the condition. For mild cases, lubricating eye drops and protective glasses can reduce watering and irritation. If there is the involvement of the optic nerve or the swelling causes eye pressure to increase to harmful levels, oral steroids or steroid injections may be needed for treatment.

As the condition becomes stable (usually after 12-18 months), the eyes can be repositioned inwards with surgery. Your ophthalmologist may also discuss surgical correction of eyelid position and double vision. 

If diagnosed with thyroid disease, it is essential to have regular testing of thyroid hormone levels and endocrinologist consultations for titration of medications, as needed. Thyroid eye disease can be treated with medications and surgery, and the eye appearance can be returned to normal.