Thyroid disease, particularly autoimmune thyroid dysfunction, can affect the eyes by causing thyroid eye disease (thyroid‑associated orbitopathy). This involves inflammation and enlargement of tissues within the orbit.
Eye Signs
Patients may develop red, swollen lids, bulging eyes, lid retraction, double vision, and, in severe cases, exposure keratopathy or optic nerve compression. Symptoms often include grittiness, watering, and light sensitivity.
- Smoking significantly increases the risk and severity of thyroid eye disease
- Changes can occur even when thyroid blood tests are normal or treated
- Both overactive and underactive thyroid states may be associated
- Clinical activity varies over time, with active and stable phases
Treatment
Management involves optimising thyroid function, protecting the ocular surface, and addressing inflammation or mechanical problems. Options include lubricants, steroids, radiotherapy, immunomodulatory drugs, and surgery in selected cases.
- Early referral to an oculoplastic or orbital specialist improves outcomes
- Smoking cessation is strongly recommended
- Regular monitoring looks for signs of optic nerve compromise
- Rehabilitative surgery may be considered once disease is inactive
