Unfortunately, having a problem with your thyroid gland is very common.
Whether you have hyperthyroid, hypothyroid or even just normal thyroid function,
it's still common to end up getting what's called thyroid eye disease. What really
sucks is a lot of medical doctors and even eye care professionals just overlook a lot
of these signs and so thyroid eye disease often goes under diagnosed and so today
we're going to review the seven signs of thyroid eye disease. Let's take a look.
Hey what's up Dr Joseph Allen here from the Doctor Eye Health show and on this channel we
help people learn all about eye diseases, glasses, contacts, lasik and everything in between. So if
you like learning about the eyes hit the subscribe button, happy to have you join us. Now the first
thing that we have to mention about thyroid eye disease is the fact that you can have
thyroid problems affecting your eyes with any level of thyroid dysfunction. Most people do
end up having hyperthyroid especially in the case of an autoimmune condition called graves disease.
Most commonly when when eye doctors or anybody in the medical field thinks of anything wrong with
the thyroid affecting the eyes they're usually thinking of graves disease, however even though
about 80 percent of all cases of thyroid eye disease is affected with someone with a
hyperthyroid about 10 of people with hypothyroid or have really low thyroid levels they can still
get this and even people with euthyroid, having normal thyroid levels, can still end up getting
a thyroid eye disease. So again this is something that not only eye doctors but even medical doctors
should be watching for. Now the first sign we often see for someone that is developing a problem
with the thyroid affecting the eyes is that of eyelid retraction and this occurs about 80 percent
of these people who are diagnosed. Now eyelid retraction usually results in people having kind
of this alarmed like stare. In fact we'll call it scleral show. If you've ever heard that term
and that's when normally just looking at somebody the top of their eyelid should come below the top
portion of their cornea, you should not see the white sclera above their cornea there. If you're
able to just in normal conversation and they're not giving a surprise look and you're able to
see that white part above the cornea, that usually may be a sign that they have this. In fact in the
eye clinic with my students that I teach I usually try to encourage them to do a test for something
called lid lag and that's where i'll have the the patient either follow my fingers or a pen and i'll
have them slowly look up and then look down look up and look down we'll do that several times, now
lid lag is in fact something that's static so when i'm having them look down i'm comparing
right and left eye because things with thyroid conditions are often asymmetric and so one eye
may have more proptosis or bulging than another and so when looking in a down gaze lid legs in
fact where one eyelid will be higher than the other. In comparison and so it's easier to tell
just which eye maybe has more scleral show than the other and that's found in about 50 percent
of all people who have some level of eyelid retraction. Now the reason I have patients
uh kind of follow my finger looking up and down is in fact so i can see the dynamic part
of it which is the van Graefe sign so i'm not just looking uh if one eye's above the other
but in fact one eye eyelid is falling down slower than the other and that's more again more of a
movement dynamic appearance and we call that that van Graefe sign in my experience van Graefe signs
a little bit more difficult to detect but it's still something to always be observing for. Now
the second sign of thyroid eye disease is that of proptosis or the medical term called exophthalmos
and that's where the eyeball basically kind of bulges outward toward you and it's probably the
most common thing that medical professionals or eye care doctors are going to think about in their
head when they think of somebody who has like graves disease or any problem with their thyroid.
The reason that the eyeballs kind of have this a bulging like appearance like they're
getting pushed out of the skull is because the eye muscles that surround the eye are in fact becoming
inflamed and swollen due to this problem with the thyroid. It's not fully understood but something
with the antibodies that are basically attacking the thyroid also have a very similar receptor
of the eye muscles and that causes the eye muscles to swell up and even become somewhat fibrotic
and because there's not enough space within the orbital cavity it basically pushes on the eyeball
and then the eyeballs bulge outward and this is a really fundamental thing to understand because of
how the eye muscles get involved that's basically what ends up causing all the problems with thyroid
eye disease to begin with. Even though this is the most common thing that most medical professionals
will be thinking about and looking for it only affects people about 60 of all the cases
diagnosed with thyroid eye disease. To be honest when i see people who have this type of appearance
yeah we're going to order a thyroid panel just to do our due diligence but you almost don't
even need to you can just tell that person's got thyroid eye disease and possibly graves disease
from like down the hallway. Now the third sign of thyroid eye disease is in fact something that
i run across all the time as an eye care professional and that's diplopia or double vision.
This happens because of restrictive orbital myopathy and this is again those eye muscles
becoming swollen and then the proteins inside the eye muscle more or less becoming somewhat fibrotic
and that means the eye muscles can't really move. Something that's interesting that eye doctors
have to learn in school is that usually the inferior recti muscles are first involved
with thyroid conditions followed by the medial recti or the ones toward the nose followed by the
superior and then the temporal muscles and this is significant because the type of diplopia that
ends up being involved. Because the inferior recti muscles are usually involved first that's why we
end up seeing people with vertical diplopia and someone will come in all of a sudden and they'll
feel like wow you know like i'm seeing double up and down with both eyes and they feel like they
need to kind of turn their head one direction to try to correct for it and then followed up
by people who have the medial recti muscles that are kind of stuck in that position they end up
with something called an esotropia where basically one eye is basically kind of cocked inward and the
other eye is looking straight ahead but then they see double more side to side now the fourth sign
of thyroid eye disease is somewhat related to this eye muscle being entrapped and that's just pain
with eye movement. Now i know pain with eye movements kind of a weird symptom to try to
describe it's not like a sharp pain most people describe it as a dull achy pain now the tough
thing is that if you really move your eyes in extreme gazes you can kind of feel a tension back
there and that's not going to be the same thing usually these people have much more defined pain
in almost any direction they move their eyes and again we'll see some subtle diplopia double vision
or other restriction of the eye muscles there are other diseases where people have pain with eye
movement and that's usually because the optic nerve head is swollen and so when the the eye
muscles move they pull on the optic nerve and you can feel a pain that way in this case this has to
do more with the eye muscles being restrictive and having more more difficult time moving
so that's that's the type of pain we're talking about here but still an important thing that eye
care professionals have to consider when somebody maybe has a thyroid problem now number five on our
list is in fact dry eyes and this perplexes a lot of people and i think a lot of eye doctors
overlook thyroid conditions as possibly being involved with any form of dry eye or red eyes
now the reason why dry eye symptoms are associated with thyroid eye disease has to do with because
those eyes are moving outward and then the eyelids aren't fully closing so a lot of people will get a
lagoph thalmos where their eyelids just aren't closing all the way and that leads to what's
called exposure keratopathy meaning the eyeballs is exposed to the air and then their tears are
evaporating that's leaving behind salt content and then the surface of the eye ends up getting
damaged and kind of like you wrote it away more specifically there is a condition called slk or
superior limbic keratoconjunctivitis and that's where during an examination i will often ask my
patients to look down and then i'll flip the upper eyelid and look underneath that eyelid on the
white part of the eye on the sclera and we expect it to be nice and white but if it looks more red
and irritated in the symptoms of dry eye then it could perhaps be this slk condition any cases
of superior limbic keratoconjunctivitis or this slk they are associated with thyroid eye disease
largely because again that top eyelid is just not retracting correctly and is rubbing more on
that top part of the eye but it's not uncommon for myself or my other colleagues to detect this and
start questioning hey does this person have some sort of a thyroid condition and do we maybe need
to order labs or talk to their family doctor and get things checked out now here on this channel
we have also done a lot of videos on dry eye treatment specifically uh if you're having dry
eye symptoms and just want to know more about what could all be going on i have a complete playlist
for that i'll put that in the description below below that like button so you can find that easily
otherwise i know a lot of people with dry eye symptoms and issues like this also often have kind
of a red eye appearance and then also goes hand in hand with thyroid conditions as well and that
really falls down to our sixth sign of thyroid eye disease and that is edema including chemosis kind
of a swelling gelatinous appearance to the surface of the eye along with redness that appears on kind
of the nine and three o'clock positions of the eye and again that all has to do with that same thing
the eyes are coming outward eyelids aren't closing completely and that leaves exposure
and inflammatory proteins to kind of accumulate on the eye even inflammation coming from the
eye recti muscles that could be leading to kind of a redness pink sides of the eye but they're
definitely more pronounced again at that three and nine o'clock positions and finally number seven
is that of optic neuropathy and thankfully this only occurs in about six percent of individuals
who have a thyroid problem now what is going on is that because the eye muscles are swelling up
and they're becoming rigid and there's no real space for the eyeball to go the optic nerve gets
compressed by these eye muscles and this can be really concerning to all eye care professionals
because when the optic nerve is being pushed on there's the risk that it's going to be permanently
damaged and so people with these thyroid issues they can end up losing parts of their visual
field and this doesn't happen very rapidly at least usually it's usually a slow process
and so people don't notice it going on but that means that people unfortunately can go blind from
thyroid dysfunction they can have permanent vision loss if it's not caught fast enough but again
that's why thankfully it's only about six percent of cases but still something that we don't want to
ignore now thankfully for most people who have a thyroid problem they're working with their family
doctor and they're getting their numbers checked they're getting on treatment and we don't see a
huge advancement in thyroid eye disease but some people unfortunately do still progress so it's
something that eye care professionals need to be watching for and even medical professionals need
to be aware that this exists the other more recent and cool thing is that at least far as treatment
goes when someone does have these severe forms of proptosis or their eyelids being involved we can
do what's called orbitally compressing surgery that's kind of the end stage thing we most eye
doctors actually prefer to try to avoid needing that because that's where we have to remove bone
and sometimes the fat around the eyes to make more room for the eyes to sit correctly or now we have
a new medication that's been fda approved called tepeeza or tepeeza it's always tough to sometimes
know how these are supposed to be pronounced but this is a new treatment that has been found to be
significant at reducing the proptosis of the eyes so again the sooner we're able to catch
things and get treatment going the better but hey if you're watching this and you have concerns that
maybe you've got one or multiple signs of this and your doctors have never really
measured your eyes for proptosis that they're sticking out of your eye or maybe you've never
had your thyroid levels checked then certainly talk with your eye care professional talk with
your family doctor seeing if you can get labs drawn and just to make sure things are doing okay
one of the things i love is how my patients are strong advocates for their own health
and i'm glad that you're here watching this and being part of this family we all need to
take better care of ourselves so kudos to you for remaining curious and taking good care of
yourself hey otherwise thanks for watching if you learned something new go ahead and
hit that like button for me and drop a comment in the section below if you have questions more
about thyroid eye disease graves disease anything going on with the surface of the eye i love
hearing your questions and being able to comment with you and maybe even make future videos based
on your comments and suggestions otherwise until next time keep an eye on it we'll see you soon