Thyroid Disease and Chronic Dry Eye

Reviewed by: HU Medical Review Board

Your immune system works to keep you healthy. It recognizes “good” cells from “bad” and launches an immune attack when it senses something that can make you sick. Antibodies are proteins that are set in motion by your immune system to protect your body from infection. When the antibodies find what they are looking for, they bind (attach) to it. A series of events within your body then happens to kill the offending organism.1

An autoimmune disorder or disease can happen when your body does not properly recognize healthy cells from invaders like viruses, fungi, or bacteria. As a result, your body can mark its own healthy cells for destruction.1

Graves’ disease and dry eye disease

Autoimmune hyperthyroidism is known as Graves’ disease. Graves’ disease is a chronic autoimmune disease. Chronic means that it lasts for a long time or never completely goes away.2

Graves’ disease causes the body to target its own healthy tissues in the thyroid. This leads to the production of too much thyroid hormone and swelling in the muscles that control eye movement. The result is Graves’ ophthalmopathy, or thyroid eye disease (TED). Signs of TED include:2

How does Graves’ disease lead to chronic dry eye?

The bulging and swelling of the eyes and eyelids that occurs with Graves’ disease may lead to dry eye disease. If the eyelids are no longer able to cover the eye, the tears may not be properly refreshed with blinking. The surface of the eye may also be exposed to air for a longer period of time. As a result, the surface of the eye may become dry and damaged over time.3
If you smoke, talk to your doctor about taking steps to stop or reduce smoking. Smokers with Graves’ disease are more likely to develop TED compared to non-smokers with Graves’ disease.4

How is thyroid eye disease treated?

If you have TED, there may be things you can do at home to help soothe your eyes and improve your vision:3

  • Apply cool compresses to your eyes. This may help soothe your eyes.
  • Wear sunglasses. This helps protect your eyes from the sun and wind. TED can cause discomfort from the light and wind, and wearing sunglasses may help.
  • Use moisturizing eye drops. Using these may help relieve dryness and scratchiness of the eyes. Do not use drops that contain redness removers, as these contain chemicals that can affect the blood vessels of your eye. Talk to your doctor about the best choice of eye drops.
  • Raise your head while sleeping. Keeping your head higher than the rest of your body while sleeping may help decrease the swelling and pressure in your eyes. Adding more pillows or even raising the head of your bed with blocks may be helpful.

Call your doctor if you are experiencing any signs or symptoms of Graves’ disease. You may require additional medicine or treatments to help. Some of these may include:3

  • Steroids – These are drugs used to decrease swelling and tone down the immune system in autoimmune conditions
  • Surgery – TED does not always require surgery. However, in some cases, surgery may be needed to prevent eye damage or vision loss. Eyelid or eye muscle surgery may be required if the eyelids are pulled back or the eye muscles are damaged. If severe swelling occurs, eyesight may be threatened. Surgery may be necessary to relieve the swelling in the eye and allow more space for swollen tissues.

It is essential that thyroid blood levels be within a healthy range so all of the organ systems in the body properly function. After treating an overactive thyroid, there is a high risk of becoming hypothyroid (an underactive gland). Maintaining a normal range of thyroid hormone may help keep thyroid eye disease from getting worse. However, it is possible to develop thyroid eye disease even with normal hormone levels.3

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