Dysthyroid Eye Disease

Also called Grave's eye disease and thyroid eye disease, dysthyroid eye disease usually occurs in persons with an overactive thyroid gland (hyperthyroidism). The eye symptoms may appear long before the thyroid gland becomes hyperactive, however. According to the Thyroid Foundation of Canada, about 10 percent of patients with dysthyroid eye disease never develop hyperthyroidism. Although both conditions are autoimmune disorders and are closely associated, they appear to be independent of each other.

Prevalence

• Several types of hyperthyroidism have been identified, and Grave's disease is the most common. About 50 percent of patients with this disorder develop some degree of dysthyroid eye disease, according to the Thyroid Foundation of Canada. Only about 2 percent of people with Grave's hyperthyroidism develop severe forms of the eye disease, as noted by the University of Dundee, Scotland. People with Grave's hyperthyroidism who smoke are nearly eight times more likely to develop dysthyroid eye disease.

Symptoms

• The primary symptom of dysthyroid eye disease is eye tissue inflammation. The eyes have a gritty sensation and are sore, irritated, red and watery. The eyelids and tissue around the eyes become puffy because of fluid retention, which is usually worse after sleeping. Symptoms become worse in sun or wind. Swelling of the muscles in the orbit make the eyes bulge out and give the person a look of wide-eyed staring. This eye-bulging is a cosmetic distress for many people.

Serious Cases

• In more serious dysthyroid eye disease cases, swelling can cause difficulty moving the eyes or pain when moving them. The patient may develop double vision. Vision can also be disrupted if swelling behind the eyeball presses on the nerve from the eye to the brain. Eye-bulging can become serious enough that the person has difficulty fully closing the eyelids.

Hyperthyroidism Treatment

• If the patient has not already been diagnosed with hyperthyroidism when dysthyroid eye disease symptoms appear, the thyroid gland will be checked and must be treated if overactive. This can be done with anti-thyroid medication to stop the gland from producing more thyroid hormone, and beta-blocker drugs to block the action of the already-circulating thyroid hormone. Radioactive iodine therapy also is commonly prescribed, in which the patient ingests a capsule or solution of radioactive iodine, and this iodine destroys the overactive thyroid cells. Surgery may be necessary if the thyroid gland becomes very swollen. These treatments can help decrease symptoms of dysthyroid eye disease.

Dysthyroid Eye Disease Treatment

• Mild to moderate cases of dysthyroid eye disease usually resolve within a few months to two years without specific eye treatment. Patients can use artificial tears to soothe irritated eyes, and if double vision occurs, special glasses with prism lenses can help. Unfortunately, the double vision may not resolve completely, and many patients continue to have bulging eyes even after other symptoms disappear.

Intensive Treatment

• In patients whose eye disease progresses even after thyroid treatment, the doctor may prescribe corticosteroids to reduce swelling and inflammation around the eyes. Immunosuppressant drugs also are a possibility, or a combination of the two. Surgery is an option for improving the appearance of the eyes.