Thyroid Disease And Your Eyes

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.

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About Dana Trentini

Dana Trentini founded Hypothyroid Mom October 2012 in memory of the unborn baby she lost to hypothyroidism. This is for informational purposes only and should not be considered a substitute for consulting your physician regarding medical advice pertaining to your health. Hypothyroid Mom includes affiliate links including the Amazon Services LLC Associates Program.

Comments

  1. 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

  2. Priyanka Chaudhari says

    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!!!

  3. 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.

  4. James Craft says

    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.

  5. Gail Reed says

    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

  6. 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.

  7. 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.

  8. Bev Douglas says

    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

  9. 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.

  10. 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

  11. 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.

  12. Michelle Nelson says

    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.

  13. Connie Conner says

    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.

  14. Peggy Stearns says

    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.

  15. 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!

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