Eye Enlargement and Inflammation
Any hyperthyroid patient, no matter what causes their hyperthyroidism,
may experience elevation of the upper eyelid anytime the blood level
of thyroid hormone is above normal. For example, patients who are
hyperthyroid because of too much thyroid hormone medication may
have raised upper eyelids causing their eyes to appear enlarged
or staring. In this situation, however, the eyes do not actually
protrude.
If you have Graves' disease, you may develop protrusion and inflammation
of your eyes without there being any evidence of infection. It is
likely to begin about the time your thyroid becomes overactive,
but it may precede your hyperthyroidism or occur years after your
thyroid function has become normal. Very rarely, the eye disorder
may occur without your having any obvious abnormality of thyroid
function at any time in your life.
More serious eye problems may occur in patients with Graves' disease
and (less commonly) Hashimoto's thyroiditis. The severity of these
conditions is unrelated to the blood level of thyroid hormone. If
the condition is mild, you may have only redness and irritation
of your eyes. On the other hand, in those rare instances when the
inflammation is more severe your eyes may protrude, you may have
double vision, and your sight may be threatened.
It should be pointed out that the thyroid eye disease does not
necessarily progress in an orderly fashion from mild to severe in
any given patient. In fact, a rapid decrease in vision can occur
due to pressure upon the optic nerve in a patient with only minimal
swelling of the eyelids. For this reason, if you have Graves' disease
and begin to show signs of eye trouble, you should have a complete
eye examination. If your eye involvement is severe, your physician
may refer you to an ophthalmologist (eye specialist), who will have
at his/her disposal all of the equipment needed to evaluate the
various eye problems that may occur in Graves' disease. Your vision
can be accurately tested. The amount of eye protrusion can be accurately
measured with an exophthalmometer. The cornea and other tissues
of your eye can be examined by the use of a microscope-like instrument
known as a slit lamp. Ultrasound pictures of your eye and eye socket
(orbit) may be taken, using sound waves in a technique similar to
radar. Alternatively, your physician may request special x-rays
of your orbits done by computerized tomography (CT scan) or by a
newer technique called Magnetic Resonance Imaging (MRI). These techniques
will provide a clear picture of the inflamed tissues behind your
eye.
Treatment of your eye condition will depend upon the kind of eye
disease you have and whether it is getting worse. Mild inflammation
may be treated simply by elevating the head of your bed at night
and by lubricating your eyes with drops of "artificial tears."
On the other hand, if you have a severe and rapidly progressive
inflammatory condition with double vision or decreased vision, you
may require special glasses or treatment with steroids. If your
eye tissues continue to swell despite the use of steroid hormones,
additional therapy is available. This may include x-ray treatments
to the tissues behind the eye or surgery on the bony orbit (surgical
decompression) to relieve the increased pressure behind your eye.
New research suggests that cigarette smokers are at greater risk
for these troubles than non-smokers, so if you smoke and have just
developed Graves' disease, stop smoking at once. Fortunately, serious
eye problems are rare among thyroid patients. When they do occur,
the treatment methods are excellent and are usually successful in
improving the problem. Occasionally excessive drooping of the upper
or lower eyelids may cause cosmetic problems, but plastic eye surgery
can be very helpful for such patients.
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