An ophthalmologist describes the many eye symptoms that can present with all the various forms of thyroid disease.
Written by Alan Mendelsohn, M.D., F.A.C.S.
With all the various forms of thyroid disease, the eye of almost 100% of patients will suffer from chronic dry eyes. Why?
Thyroid disease & chronic dry eyes
The thyroid autoimmune process that takes place in Graves’ disease and Hashimoto’s thyroiditis, the very same autoimmune process that can affect the thyroid gland, also affects many structures within the eye.
The reason for symtomatic dry eyes is threefold: First, located in the upper outer quadrant of both eyelids, we have a gland called the lacrimal gland. This gland makes windshield wiper fluid 24 hours a day, which lubricates the eye, and keeps the eye healthy. Unfortunately, in the autoimmune processes with thyroid disease, the lacrimal glands become attacked and the amount of aqueous produced (or basically the amount of windshield wiper fluid) is decreased considerably. That factor alone is a major reason why those with thyroid disease have dry eyes in almost 100% of patients, however, to varying extents.
There’s a second problem with thyroid disease affecting the eyes, especially with hyperthyroidism, whereby the eye will tend to bulge forward, referred to as “Proptosis” which leaves the outer wall of the eye more exposed as a result of the eye bulging forward. What happens is the cornea will dry out much more readily which itself creates more dry eye.
Strike one: The lacrimal gland makes less fluid.
Strike two: The eye frequently is bulging out a little.
Strike three: There’s a third reason and that’s eyelid retraction.
The upper and lower eyelids should partially cover the cornea to a certain extent, more so by the upper eyelids. In thyroid disease, there can be eyelid retraction, whereby the upper eyelid and the lower eyelid both do not cover the corneal surface and this is readily apparent by the fact that one can see the white of the underlying sclera between the eyelid and the corneal surface, referred to as eyelid retraction. The presence of eyelid retraction is indicative of ocular pathology with an underlying cause. This eyelid retraction further dries out the corneal surface.
Between a combination of one or usually more of these three factors, patients with thyroid disease are almost universally afflicted with symptomatic dry eyes.
Even frequent lubricating drops every two hours, may not be sufficient to keep the eye well lubricated, comfortable, and healthy. When frequent eyedrops and even topical ocular ointments are insufficient to maintain adequate lubrication, punctal plugs are an option to consider. These are the little openings within our eyelids in the inner aspect called puncta, where the tear film will drain out. In a two-minute office procedure that is painless, an eye physician can insert punctal plugs that inhibit the fluid bathing the outer surface of the eye from draining so rapidly. In essence, the existing fluid will helpfully remain on the ocular surface for a longer duration no matter whether the fluid originated from one’s own lacrimaly glands or via artificial tears that are periodically instilled, albeit at a far less frequent rate.
Prevalence of ocular symptoms in thyroid disease
As we discussed, of those afflicted with thyroid disease, close to 100 percent develop dry eyes. Additionally, approximately 90 percent have eye lid retraction whereby the upper lid goes up, leaving bare sclera between the lid and cornea while concurrently, the lower lid goes down further, leaving bare sclera between the superior aspect of the lower eyelid and the cornea. With eyelid retraction an observer will notice that with the individual with thyroid disease one can see the white sclera wall that’s normally covered by the eyelids. Furthermore, the eye bulging forward or proptosis is present in about 60% of patients with thyroid disease. These ocular physical signs are the most prevalent.
When the eye looks from one side to the other, or looks up and down, of course, that should be a painless. Looking around is what we do normally all day long. However, in those with thyroid disease, because of the autoimmune process, the muscles called the extraocular muscles can become involved and just that minor extraocular muscle movement, patients will say, the eye feels full or they have a little bit of discomfort with moving the eye. We call this “pain on motion”. There are very few things that cause pain on motion, including cellulitis and thyroid eye disease but it’s always a worry when this pain is present because looking side to side should never elicit pain. If it gets worse and worse, there can be considerable pain or even the eye will stop moving totally the way that it should and that can result in the patient noticing double vision. Around 10 – 20 percent of patients with thyroid eye disease will come in complaining of double vision.
Tragically about 1 or 2 percent of people can have a permanent loss of vision. Sometimes it’s caused by scarring of the cornea but, more often, the inflammatory process can involve the nerve in the back of the eye, called the optic nerve, causing permanent damage to the nerve and result in permanent loss of vision. Frequently there’ll be large blind spots.
Anyone who has hypothyroidism, hyperthyroidism, or any issues with the thyroid at all definitely should be monitored closely by an eye physician at a minimum of twice a year but, whenever there’s a flare up, the frequency of eye exams should be more frequent as needed.
About Dr. Alan Mendelsohn
Dr Alan Mendelsohn is an ophthalmologist in Hollywood, Florida since 1987. He is a pioneer cataract surgeon at Eye Surgeons & Consultants dedicated to increasing the awareness of serious eye issues.
My eyes swell if over or undermedicated with thyroid medication. I do not have an autoimmune disease. Under medicated my eyes are puffy and over medicated the upper part of my eyes swell up.
Has anyone tried to change their food habits to improve on their symptoms? I’m trying but not yes 100% gluten free, avoid anything preservative, artificial, colours, processed and seed oil containing food.
Hi Heba, Yes identifying my food sensitivities has been an important part of my own healing. Many of my Hypothyroid Mom readers tell me that dietary changes based on their specific food sensitivities has helped them too. However I have found that food sensitivities are highly individual. What is a “good” food or “bad” food for one person may not be for another person which is why it is about finding your own sensitivities. If there are two foods above all that people seem to have more troubles with than others it would be gluten and dairy. I hear from many people that feel better when they try gluten and/or dairy free but it isn’t a universal response. Many people will also tell me that they found no difference. It is about trying it for yourself to see how you do. Here is an article about the relationship between thyroid and gluten: https://hypothyroidmom.com/gluten-why-hypothyroidism-patients-often-fail-to-get-better/
I have had hypothyroidism/hashimotos for 30 years. And have been having issues with my eyes for a while not really realising what it was. As all of a sudden they would start to run, I didn’t realise this was a symptom of dry eye. Why would you when your eyes flood, but it is cause they are so dry that blinking causes them to water. I also out of the blue had my vision suddenly spin one day and I couldn’t see properly. Fortunately I was working in a hospital and was able to get checked out by the ophthalmologist. Turned out that I had become partially sighted following brain surgery I had back in 2003, and was now highly likely to have myesthenia Gravis(MG). But needed a blood test and to be seen by a neurologist. Fortunately I was under a neurologist due to my epilepsy so contacted him and my GP for the blood test. The ophthalmologist has been seeing me regularly since and adjusting my glasses (have been short sighted since I was 12 years old) as required for double vision,, I am now under a specialist ophthalmologist that I see annually as well. The blood test have come back negative every time but due to changes in my vision I have been put on low treatment for MG initially for first six months worked well but now still have the double vision. And having had thyroid blood’s checked have had medication reduced.
But right now I am shattered with rubbish vision so if thyroid can be causing effects over the years then it sucks, cause I have definitely hit a circle with thyroid making my body unwell
I’m sorry to hear your struggle with your eyes, Sarah. While there are so many possible causes for eye problems, I wonder how often the thyroid is missed. Good to have you here at Hypothyroid Mom.
I’ve had hypothyroidism for 3 years now. My eyes lately have been hurting and really dry .Also abit of blurry vision in my left eye some times. I’m going to get that checked out with my GP. Thanks for the article brilliant advice and important information 😊take care everyone and wish you all well….
Wonderful to know that you found the Hypothyroid Mom article helpful, Juliana. Great to have you here. All the best, Dana Trentini
I have had hyperthyroidism and Graves’ disease since I was 13, treated with RAI at 16, and by 22 was hypo. I have the eye damage, protruding eyes. Fast forward in about 2013 I started with issues of my right eye looking open wider had to have eyelid surgery to lower my eye lid. Now in 2021 at age 48 I also got Lyme, now everything hurts, I feel as though graves is acting up, left eye seems wider wondering if I am going to need surgery. Never ending. I wish my eyes didn’t bulge and no idea what next step should be. Oh and I have been taking Armour thyroid for about 8 years.
Holly,
I truly empathize with you. I was diagnosed with Graves/hyperthyroidism in 2017 and then Bartonella Henselae (Cat Scratch Disease) just about a month ago. I hear you on everything hurting and often wonder which pain belongs to which disease. Reading your comment makes me pose the question of whether thyroid disease and Lyme type diseases/co-infections are related in any type of way? Wondering how common this is? Most importantly, wishing you peace and hoping that you can experience moments of joy throughout your health journey.
Not everyone does well on Armour…speaking from personal experience.
Very true Tamara. I wish it was simple to say one thyroid medication worked for everyone but it’s more complex than that. I react poorly to many brands of thyroid medication including natural desiccated thyroid. It shouldn’t be so difficult but it is. What medication have you found works best for you? All the best, Dana Trentini (Hypothyroid Mom)
My Endro took me off all meds.
Extremely allergic ER ambulance allergic to levothyroxine Synthroid and Tirsonet SOL. Armour causes severe heart palpitations I’m 76. My test show TT3 in range but my TSH is not. All meds send my # hyper. No meds I’m hypo. I feel good hypo.
Agree, sounds like ophthalmic migraine.
I’m struggling now hold my Jon down told my gp for years wasn’t myself eventually seven years later diagnosed hypothyroidism my meds are tweaked just about every three months 50mg. to 150mg daily or higher. Feel crap all time dry eyes I feel my right eyes to big for my socket too
Don’t like going to my doctor feel he don’t understand leave with same answers every time.
Job guys sorry
People don’t understand as it’s invisible illness. Don’t like say this you won’t get any better- left it undiagnosed to long. Seem be having terrible time. Why do you suffer in silence surely there’s someone you can talk to As THYRIOD sufferer myself I sympathise with you. Bless you
I’m sorry to hear your struggle Reesha. You are not alone. Wishing you better health for 2022, Dana Trentini (Hypothyroid Mom)
I’m really sorry to hear about this. Wish you better health for the future Reesha. You are not alone..
Last year had dizziness for one week and following month vision had central blurriness. Saw an eye doctor who asked if I had looked at an eclipse. I replied no. I’m currently on Levothyroxine. Anyone else have this issue.?
Hi Michele, After a decade as Hypothyroid Mom, I have heard so many different symptoms from my followers that nothing surprises me anymore. My mother and brother also have hypothyroidism (it does tend to be genetic although not always) and dizziness/vertigo are some of their most problematic symptoms since becoming hypothyroidism. I do not suffer from dizziness. I say this because what I have learned is that this condition affects every person differently and we all have a different combination of symptoms. If you feel something isn’t right with your body, get multiple medical opinions because our hunches are often right. Regards, Dana Trentini (aka Hypothyroid Mom)
I had vertigo a few years back so bad I was hospitalized. Now when ever I feel dizziness coming on I take motion sickness pills. OTC keeps it fro getting bad again.
I definitely have problems with thyroid eye disease and dizziness.
I read vitamin A can help with dry eye. Has anyone ever heard of that?
I have hypothyroidism, no issues with eyes except I get this prism that starts small then it grows,as it grows, where the prism is I cannot see but I can see around it. Like looking at the sun, you cant see where the sun is but you see sky around it. I’ve asked maanny doctors but none have heard anything about it. I’ve had approx 15 episodes since 2003. I hadn’t had one in about 2 years and out of the blue it popped up. I’ll ask again tomorrow at new eye dr again… if you’ve had this, let me know
Sounds like an ocular migraine.
I had that a few times, too. As Penny suggested, it’s probably a form of migraine. Mine went away once I started taking an NDT. Good luck with it.
I have had this my dr said it was a Auro and I tend to get it when I’m have to much thyroid meds it is so scary but I have had it for years
oh my luv. its called a silent migraine. scary when you don’t know what it is but it’s nothing to worry about 🙂 mine are triggered by caffeine. look them up x
Ocular migraine I think. Mine triggers full on migraines about an hour after the visual craziness happens. I used to take fioricet but now doctors won’t prescribe it and I’m allergic to the ingredients in what they want to prescribe. Prescription drugs are ruled by profit and trend. Having an emergency supply of fioricet to help with a migraine and all my other pains, as I have Ehlers-Danlos Syndrome. Everyone in my EDS support group has thyroid disease and eye issues and migraines and pain…… I just had rapid onset cataracts corrected and my dry eyes are killing me and my eyes are often bloodshot and my eye surgeon commented on my lower lids showing the whites of my eyes and that I could get plastic surgery on my eyes to pull them up…. But I had just commented on my weight gain and thyroid disease and he didn’t connect my eye troubles with my thyroid. Also, he’s clueless about EDS. I don’t heal well because of EDS and plastic surgery would be very risky. The first set of puncta plugs, he practically killed me. Very rough handling and put in gigantic plugs without asking me if that was ok, and my eyes were very irritated from that. It’s common sense that you don’t act forcefully and ram extra large plugs into any patient, let alone someone with a connective tissue disorder. Having bad insurance makes me limited to who I can get as a doctor. I really hate it when all my doctors have tunnel vision. Pun intended. Prayers for all of you. I hope the best for all of us in the struggle.
I have Hashimotos and the dryest eyes! I can tell when I wake up if I’ve eaten gluten or something I shouldn’t have, based on how my eyes feels. I also have a nevus in my retina I have to have scanned and watch regularly.
Eye health is so important!
I have pain in my eyeballs like it is bruised. If i touch my eyes it hurts. Moving my eyes left and right causes me to get dizzy, even when just moving my head. I am sensitive to bright lights. I often massage my eye balls to try to get relief.
Yessss! Dizzy when move eyes right to left and a constant ringing in my ears to go with it! Can it be fixed? Is yours fixed yet? I really believe my doctors think I am crazy. But I know what is normal and what is off.
stop doing that. I developed cataracts from constantly massaging them to relieve the pain.
Make sure your Thyroid medication has SYNTHROID written on the pill. It makes a difference in brand and generic. My hair was thinning and breaking when I was taking Levithyroxin. Now that I am taking the actual SYNTHROID it has stopped and I feel my energy level has increased without having a supplement to boost my energy, my recall and overall memory has improved tremendously and my eyes aren’t as dry…donot need eyedrops repeatedly during the day and night
I lost tons of hair with Synthroid, but Levithyroxin made me feel better and the hair loss stopped. I believe it may differ for everyone.
I have permanent vision loss in my right eye from optic neuritis of unknown cause. I have Hashimo disease and no one ever told me about the thyroid optic neuritis connection. I was treated at U Penn by a neuro opthmalogist , who never even mentioned this as a possible cause but put me through a battery of expensive tests and a full body MRI.
I’m so sorry to read this about your eye. It is a tragedy what is happening to thyroid patients. Wishing you good wishes ahead, Dana Trentini (aka Hypothyroid Mom)
Optic neuritis is typically a first prominent symptom in multiple sclerosis. I would definitely recommend seeing a neurologist.
I’m a nurse and a MS patient.
I had the same problem I had also been on Levothyroxine for 21 years is there any thing that can be doing about light sensitive
Levothyroxine isn’t a consistently effective thyroid hormone replacement. It is the ‘Go-to’ because it’s the cheapest! I would highly recommend Armour Thyroid, it’s natural and every person I’ve talked to has had the same results: we finally feel like ourselves, physically and mentally. I have Graves Disease, undiagnosed for 10 years and it nearly killed me. I also have it in my right eye, which bulged horribly! Doctors wanted to do surgery to shave the orbital bone and recess the eye. There’s a 34% chance of double vision. It would then be a 5-6 month healing period before they could do corrective surgery! I decided to use anti-inflammatories and ice packs. It worked! My eye is normal. I hope this helps. I handle light sensitivity with transitional glasses to minimize the issue, dark sunglasses outside.
Magnesium supplement can help with light sensitivity
Thank you all for this very helpful info. I have Graves’ disease and have taken Levi thyroid for about 20 years. I’ve always had redness and tired eyes but it has recently worsened. My family thought I was exaggerating when I complained of light sensitivity. I even questioned myself at times as to why I preferred soft lighting and sought shady trees in the sunshine. I was wondering if once it becomes more irritating on a regular basis, as it has, if it is progressive or can be permanently reversed. Any input would be awesome. Thanks again!
Thank you for this information. I have hypothyroidism hoshimottios and never knew about this ive had dry eye issues for years but my doctor never mentioned this. I will now ask my doctor to recheck my eyes and try to finally get some relief
Hey, thanks for the great information, it really helps not only to know the problem of thyroid
but also simultaneous treatment regarding thyroid…Thank you so much for your direction!!!
I developed in the early ’90s a condition called corneal dystrophy Very painful. The cause was never mentioned by several Drs. Finally in San Antonio the Opthamoligist (sp) told me to get a blood test for thyroid. I was told not only was my thyroid underactive, it was totally not active at all, and had probably been that way for just about 10 years. I have been on pills ever since and have my thyroid checked very 6 months. I don’t have any corneal dystrophy attacks and my vision has straightened out pretty good. I think the blood test for thyroid function should be part of the yearly checkup.
Never ever had eye sight issues other that glasses for the last 50 plus years. Three years ago had a thyroidectomy due to cancer and removal of all four parathyroids found inside my thyroid at Vanderbilt. They found a fifth parathyroid and transplanted into my arm an d it is worling well. I’m a teaching case now at Vandy. About a week after this procedure I noticed my eyes were hurting from sunshine and it kept getting worse . I never wore sunglasses before all this happening. Been to several eye docs with no real help.
I have suffered most of my adult life with eyes that never stop running . I have Hashimoto thyroditis & was told that it’s called dry eye , & the reason they are always wet & running is that the glands in my eyes over compensate by making too much fluid to rectify the dry eye .
It’s an oxymoron & people can’t understand when I explain the reason I’m always wiping my eyes . Even chemists try to sell me products to produce more tears & don’t understand when I explain my problem to them ….. I need something to stop the tears not make more , it’s frustrating & annoyingly problematic…🤷♀️
I have the exact same problem! Good to know it’s not just me. I have Hashimotos and Celiac Disease and severe chemical sensitivity plus allergies. The “Golden Years” is a big lie! I’d like to find who quoted that and kick them in their shins 😁 My only saving grace is my three grandsons! They keep me going especially on my bad days. You’re in my prayers because I know exactly what you go through. Take care
Hi Sandra, thank you so much for your message! I myself have had an under active thyroid been to so many doctors and no one can help! I have so many symptoms but every time I see a new doctor they tell me my eyes are not part of my under active thyroid. I have struggled for 5 years with weight gain regardless of eating right boxing 6 days a week twice a day and taking my thyroid medication. I ask myself what can doctors be missing??
I had the same issue. My puncta were closed. Had two procedures that didn’t work, 3rd one was more invasive, so far it’s working. If your puncta are closed, there’s no where for the tears to go and they just run down your face
I’ve been to visit multiple opticians and they’ve not once said that they knew that thyroid disease effects eye dryness. There should be more education about this to medical and ophthalmic students.
My eyes are so dry that I am unable to wear contacts. They stay moist for 3 seconds, when the minimum recommended is 10seconds. Does anyone successfully wear contacts and if so how and which brand is best?
I had to change to dailies. It helps but my eyes are still dry and I constantly put drops in. Double edged sword for me. The contacts help significantly with the double vision over glasses.
Hi,
I’m 64 years old and started with mild dry eye symptoms about two years ago. At the time my optometrist said it was age related. A year ago I had a thyroidectomy due to cancer. All went well and no treatment was needed. Afterward I noticed my eyes were becoming drier and drier. Went back to the optometrist and he prescribed Xiidra. I tried it faithfully for a year and it did nothing. Tried over the counter name brand eye lubricants. Short lived relief. I’ve often wondered if having my thyroid removed has increased my dry eyes? I am using contact lenses called, Dailies Total by Alcon. They contain the highest amount of moisture in a contact lens. I can wear them without any eye itching or redness. They are very expensive even though insurance covers a portion of it and once you buy the year supply, you can apply for the $150 rebate. It’s worth a try, good luck!
There are very few doctors in the US who truly understand and specialize in thyroid treatment using older medications, like Armour, Iodine, chelations and others, that truly CORRECT the problem [not just treat the symptoms] and without the horrid side effects of big pharma levothyroxine and others. Your ‘usual’ endocrinologist or rheumatologist is NOT one of these. Search until you find one of these Drs. who will easily help you get your life and health back.
what kind of Dr is this that will help
A Health and Wellness Doctor who prescribes Armour Thyroid – the natural form of thyroid replacement.
Not everyone does well on Armour…speaking from personal experience.
Dry eye problem will go away with flexseed and oil of it
Can you clarify?
Three years ago I had oral cancer, and spent 6 weeks in hospital at which time was tube feed. I regularly now have had CT scans, and have found that the contrast in the dyes used for these scans effect my thyroid, resulting in ie sensitivity to cold, my temperature which now with covid is regularly taken at hospital visits is 34 deg and I have also developed itchy skin and tiredness, also have found problems with dry eyes Hope this is of help regarding being mindful of CT scans
I now think that chronic dry eyes was one of my early symptoms. I already had one diagnosed autoimmune issue, but it was years later before I had full-blown and diagnosed Hashimoto’s. One Dr dismissed my complaint of dry eyes. But one examined me and actually asked if I had any thyroid issues! He knew! He used a newer technology and saw inflammation at lower levels of my eyes, too. Two years after diet changes and medication, he compared my eyes and noted a decrease in inflammation. I still have dryness, though it is better than before.
Hi , I have hypothyroid since I was 20 and now 60 and my eyes went from being perfectly fine to so dry I use drops all day and cataracts. Each time they increase my ya thyroid but all that does is make me have rapid heartbeat . I have hashinoto disease , terrible arthritis , terrible allergies and Thyroid problem seem to lead to everything else . Wish there were a better answer then to keep increasing medicine as now my ultrasound shows thyroid atrophy because it has shrunk to less than half the size . Any good news would be great. Thank you , Sally
my last test results said I still had hyperthyroidism antibodies, 4 years after my TT which is why I still had vision problems with light sensitivity and overall blurriness; couldn’t go out without shades, couldn’t drive at night without glasses.
This would explain why it is impossible for me to wear contacts. My eyes would be incredibly dry and it makes it so difficult to be able to have them. I’ve had eyeglasses since I was 11. I have Hashimoto’s disease & hypothyroidism. Being 40, I should feel relatively still young but with this condition, my body says otherwise. Really wished I did not have to deal with this condition and be able to feel normal.
I have been searching for answers for myself constant red and dry eyes. No one has given me any answers. One eye doctor recommended a rheumatologist. She found nothing. Thank you. I have had Hashimoto disease for 10 years. That’s when the red eyes became a problem.
I have had my thyroid removed. And I have double vision. What can I do about it. Need glasses. But they don’t know how to fit me Eye exam changes as testingvgoes on. I see little better with one then next time it’s a little better with diff one. The double vision never goes completely away Peggy
I had my thyroid removed about 10 years ago. Approximately 9 years ago I went from double vision to 4 times seeing everything with more and more stronger glasses. Then 5 years ago my right eye disconnected long story short went to brands hospital in St Louis had surgery and since then no multiple vision, in the last year and half wearing reading glasses only.
Contacts helped my double vision significantly but doesn’t help the dry eye issue. I use dailies which seem to be best for the dry eye but still use drops constantly.
Hi, thanks for the info. I did not realize that problems with the thyroid gland could lead to such consequences with the eyes. It is very good that I learned about it now and can monitor the state of my eyes as well. Be careful and think as one problem can cause the appearance of many more additional diseases. I am trying to be treated now, I hope problems with the thyroid gland will not affect my other organs. Have a nice day!