An Eye for Thyroid Disorder
Dr Dr Milind Naik, Consultant & Head, Department of Ophthalmic Plastic Surgery, L V Prasad Eye Institute, Hyderabad
Thyroid disorders and the eye have a unique relationship. This immunological disorder peculiarly affects the tissues around and behind the eye. The condition can be quite frustrating for the patient, and the treatment can be slow and complex. Here is a simplified version of what you should know about thyroid disorder and the eye.
Thyroid disorders result from either over-functioning (hyper thyroidism) or under-functioning (hypothyroidism) of the thyroid gland. Though these two types have various effects on your body as a whole, a subset of these patients develop eye problems. These eye problems can be divided into two phases, as identified by eye specialists: The ‘Active’ phase is when the disease begins. The patient may have pain around the eyes, excessive watering, redness, and swelling around the eyes. The complaints are more in the morning hours and often fluctuate in severity over the days and weeks. Gradually, the eye may begin to protrude (prominent eyes), and the patient develops a staring ‘angry’ look. In severe cases, double vision and even reduction in vision can occur due to compression on the optic nerve. The active stage usually lasts for 12-18 months. Treatment in this phase mainly comprises lubricating eye drops and steroids to reduce the swelling. Simultaneously, the thyroid levels need to be controlled by consulting an endocrinologist if they are deranged.
Once the active phase ends, the patient enters the ‘inactive’ phase. During this time, the repeated swelling and redness may reduce, but the after-effects persist, such as prominent eyes and ‘staring’ look. Most patients end up losing their ‘normal’ look, and seek cosmetic correction of the eyes to restore their natural look. The Inactive phase is the right time to perform surgeries to correct the deformity. The commonest surgery that is needed is a ‘key-hole decompression’. If you compare the eye-socket to an ice-cream cone, and imagine the eyeball as an ice-cream scoop, the decompression surgery achieves widening of this cone (through hidden incisions) so as to allow the eyeball (the scoop) to relax back into its natural position.
It is a common myth that control of thyroid levels or treatment with steroids will reverse the eye findings. It rarely does. Medical treatment in the ‘active’ phase merely pushes the ‘fast-forward’ button, so that you arrive at the inactive phase early, to get early surgical correction. In a third of the patients, this ‘eye component’ of thyroid disease can occur even if their thyroid blood levels are normal.
To summarize, thyroid eye disease has an active and inactive phase. The active phase needs medical treatment, followed by the inactive phase when surgical treatment restores normal appearance.