[Anonymous July 14, 1998 at 3:55 pm Post count: 93172]

#1050196

For anyone new or anyone who is suffering from eye problems or who thinks
they are suffering, here is some interesting information from my own reading and collection!

Some facts on the eye disease

People with thyroid disorders often have eye problems. Usually problems are limited to mild eye discomfort or temporary
cosmetic effects, but sometimes the eye disease can be severe enough to cause permanent changes in the appearance of the
eyes. Even more rarely, the eye disease may threaten vision itself.

The eye problems, like the thyroid disorders, are produced by the actions of inflammatory white blood cells called
lymphocytes. These cells cause a reaction in the muscle and fat behind the eyes which leads to the accumulation of fluid. The
actual cause is not known, and there is no way of preventing it. The swollen muscles behind the eye then push the eyes
forward, causing the eyes to appear more prominent.

Thyroid-related problems, usually called Graves’ disease, are unpredictable in their development and can progress despite
successful control of the thyroid problems. Overall, about 70% of people with thyroid disease have some sort of eye trouble.
Most develop the eye disease within a year of developing thyroid disease. In some patients, however, the eye changes may
not appear until much later, after the thyroid problem has been treated and controlled. Rarely, eye problems can occur in
patients who seem to have completely normal thyroid glands, a condition known as “euthyroid Graves’ disease.”

Classification

Eyelid Problems
The most common sign of eye trouble in hyperthyroidism is elevation of the upper eye lids, which gives the patient the
appearance of “staring” at others. This eyelid problem is called eyelid retraction. Other than symptoms of dryness and
irritation, eyelid retraction causes few problems. It usually improves as the thyroid condition is brought under control. It can be
corrected with outpatient surgery, which improves the appearance.

Swelling and puffiness of the eyelids is another very common problem with mild thyroid eye disease. This puffiness is caused
by fluid retention around the eye, and is worse in the morning.

Protrusion of the Eyes
Forward protrusion of the eyes can develop from swelling of the fat and muscle around and behind the eyes. Since the eyes
are surrounded by bone on all sides except the front, swelling causes the eyes to bulge forward. This situation is
uncomfortable and makes the eyes vulnerable to abrasions. Also the swelling behind the eyes may cause a feeling of pressure
and pain.

Double Vision
The more severe complications of thyroid eye disease may damage vision. For example, some patients begin to “see double,”
especially when they look down or off to one side. When the muscles that rotate the eyes become so swollen or scarred that
they cannot function properly, then the eyes are not properly aligned and the patient sees two images instead of one. This can
be a debilitating problem, since double vision interferes with daily activities, including driving and reading. Covering one eye
will eliminate the double vision, but also deprives the individual of a sense of depth of vision.

Cornea Problems
The front surface of the eyeball, which is clear, is called the “cornea.” Corneal involvement is a potentially very serious eye
problem. When the cornea is exposed for long periods, its surface can become dry or even infected. Therefore doctors take
special precautions to protect the cornea from this serious eye complication.

Optic Nerve Damage
The worst complication is damage to the “optic nerve.” The optic nerve, which transmits vision from the eye to the brain, can
be damaged by pressure. Loss of vision may be so gradual that the patient may be unaware of any change even though color
perception and vision itself are slowly reduced. This problem can usually be corrected with early treatment, but not after
permanent optic nerve damage has occurred.

The eye changes associated with thyroid disease are different in each patient, and do not follow a set pattern. If eye problems
do appear, the patient should be examined regularly by an eye specialist.

The Eye Evaluation
If you have symptoms of possible eye involvement, then you need a thorough eye examination. The eye doctor may
recommend special tests. “Scans” of the eye, including ultrasound, CT scan, and magnetic resonance imaging (MRI), are used
to measure the amount of swelling of the eye muscles and surrounding fat. They help distinguish thyroid eye problems from
other conditions that cause protruding eyes, such as tumors or enlarged blood vessels.

Treatment
Treatment of thyroid eye disease varies from providing comfort for minor congestion to surgical correction of serious
complications.

Eyelid Problems
The frequent irritation and congestion that results from eyelid retraction and dry eyes may be helped with simple lubricating
eye drops (artificial tears). The drops can be used as often as necessary to control the symptoms. Protective eyeglasses that
reduce exposure to wind, smoke, and other irritants can also be helpful.

Since thyroid eye symptoms are usually worse in the early morning, head elevation at night while sleeping may reduce eye
swelling by decreasing fluid accumulation around the eyes.

When eyelid retraction is quite prominent and has been stable for several months, it can be corrected surgically by adjusting
the eyelid muscles.

Double Vision
Although double vision is uncommon, it can be a disabling problem. For minor degrees of double vision, prisms incorporated
into glasses (which look no different from ordinary glasses), may be of considerable help. When the deviation of the eyes is
large, surgery on the eye muscles can be used to get them into better balance.

Serious Complications of Protrusion
The serious complications of excessive eye protrusion, (corneal exposure and optic nerve pressure) require more serious
treatment. When the eye tissues are severely inflamed, high doses of cortisone (steroids) can usually reduce inflammation and
are likely to improve the situation at least temporarily. Prednisone is the most commonly used steroid.

Unfortunately, these drugs are very potent, affect many body functions, and can have significant side effects. Therefore, they
are only used for short periods of several weeks during which you should be examined periodically by your doctor. Steroids
do not cure the process but may stabilize it, and provide temporary and often dramatic relief of eye symptoms.

Radiation treatment of the eyes with low doses of X-rays also may reduce inflammation, and has the advantage of a longer
and more permanent effect on the eye problem. These X-ray treatments are often employed along with steroid therapy. This
relatively new treatment is proving successful in helping many patients with severe thyroid eye problems.

Surgery on The Orbit
“Surgical decompression” of the orbits is the last step for patients with serious eye involvement. This operation removes some
of the bone that surrounds the eye to create space for expansion of the swollen fat and muscles, allowing the eye to move
back to a more normal position. Decompression operations are frequently followed by additional adjustments of the eyelids
and eye muscles.

This combination of treatments for thyroid eye disease, done in timely fashion, are usually successful in restoring eye function
and comfort. Close communication between a patient’s regular physician and the ophthalmologist is essential.

Fortunately, most patients with thyroid disease never develop serious eye problems, and, if mild ones develop, they usually
resolve on their own without any specific treatment. If you are having eye problems, be sure to let your doctor know so that
you can receive an eye evaluation and appropriate treatment.

Hope this helps you with those peepers!!
Dee

[Author]

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