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  • Writer's pictureJantz Chappel

Thyroid and your eyes

Updated: Nov 7, 2023

I feel like thyroid disease has become more common in the last handful of years most likely due to more testing of the disease. What a lot of people don't know is how it can affect the eyes. If your thyroid is overactive (hyperthyroidism/graves disease) you can get things like dry eye, proptosis (image below), eye movement restriction, and double vision. The last 3 are all caused by the fat around the eyes and muscles that moves the eyes get inflamed/swollen. This can trap the eyes causing restricted eye movement and double vision if it gets bad enough. If it gets really bad causes proptosis which is the eye physically looking like it will pop out of your head (they won't but it can be very dramatic photo is at the very bottom). Never underestimate dry eye it can cause a lot of problems themselves, including distortion of vision, irritation, and redness to just name a few. Now we go to the opposite end and go to underreacting thyroid with hypothyroidism/myasthenia gravies. This can cause some of the same side effects like dry eye, ptosis (image below), and double vision. This is due to underacting muscles. Your muscle is exhausted and not working properly. Ptosis is upper eyelid drooping which normally worst at the end of the day. Double vision is due to eye muscles not working properly.

What can we do to fix this? As optometrists only one we can't do a whole lot with is proptosis but there is new medication to help with this which is great because it use to be only surgery or trying to get the thyroid under control and hope this fixes it. Eye movement restriction is a lot harder and normally involves pressing on a prism to help expand your peripheral vision so your eyes don't move too much while the above methods work and hopefully remove the issue. Ptosis (eyelid droop) can be fixed by surgery but can also be fixed by a drop called Upneeq. For double vision, we can put a prism in the glasses to move the images to make them single again. Last is dry eye and honestly can be the most complex of the things to fix. I can take 30 minutes to fix all the above problems that I can fix but dry eye can take 30 minutes to just explain what to do. We may need to do Lumeis (Optilight IPL), Sclearal lens for exposure, Omega 3, Heat mask, Sleep mask, Mixture of gel, and artificial tears. The list is almost endless and extreme cases need to be customized to you. If your eye can't blink across your whole cornea, due to proptosis, it completely different beast than mild dry eye.

child with ptosis

someone with proptosis due to thyroid issues

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