Dry eyes from thyroid disease

In addition to changes in the size of the thyroid and nodules or tumours on the thyroid, an overactive thyroid (hyperthyroidism) or underactive thyroid (hypothyroidism) are among the most common thyroid diseases.

The thyroid then either produces too many hormones or too few. In addition to iodine deficiency, genetic predisposition or a thyroid tumour, an autoimmune disease such as Graves’ disease or Hashimoto’s thyroiditis can also cause thyroid disease. Hashimoto’s and Graves’ disease are among the thyroid diseases that cannot be cured. In principle, however, an overactive or underactive thyroid can be well compensated for by taking medication.

Thyroid diseases usually cause very diffuse symptoms. Since the hormonal imbalance affects the metabolism, any disease of the thyroid manifests itself through a variety of symptoms, which usually develop subtly and can affect all bodily functions.

In hyperthyroidism, the thyroid releases too much of the thyroid hormones T3 and T4. This makes the body overactive and restless. Conversely, in hypothyroidism, the thyroid releases too little of the thyroid hormones T3 and T4. Affected people feel exhausted and lacking motivation as a result.

In case of an overactive thyroid, the following symptoms can occur:

• nervousness
• irritability
• inner anxiety
• weight loss
• hair loss
• sweating
• elevated blood pressure
• accelerated pulse
• racing heart
• diarrhoea
• muscle ache

With an underactive thyroid, on the other hand, the exact opposite can be the case:

• tiredness
• lack of motivation
• lack of energy
• concentration problems
• weight gain
• constipation
• hair loss
• decreased heart rate
• low blood pressure
• dry, flaky skin
• dry eyes
• swollen eyes
• dry mucous membranes

In general, a hormonal imbalance caused by thyroid disorders can make itself felt through an altered tear film, which leads to drier eyes. This is because hormone levels also affect the mucous membranes. Particularly in the case of underactive thyroid, not enough fluid is produced, which means that not only the nose, throat and mouth can become dry, but the eyes can as well.

However, a specific thyroid disease particularly affects the eyes and is often diagnosed by the changes in the eyes – Graves’ disease. This is an autoimmune disease in which the body produces antibodies against parts of the thyroid gland. The reaction is an overproduction of thyroid hormones, resulting in hyperthyroidism. Graves’ disease is even considered the most common cause of hyperthyroidism.

A typical symptom of Graves’ disease is inflammation-related swelling of the tissues in the eye sockets, also known as endocrine orbitopathy. These tissue swelling causes the eyes to protrude from the sockets in a clearly visible way. There are usually other symptoms as well, such as

• dry eyes
• watery eyes
• burning eyes
• eye redness
• sore eyes
• swelling of the eyelids
• inflammation of the cornea or conjunctiva
• impaired vision
• sensitivity to light
• headaches

Due to the protrusion of the eyeballs, many sufferers can no longer close their eyelids completely when blinking. This dries out the surface of the eye, which facilitates inflammation and infection of the eye.

The most common cause of hypothyroidism is the loss of originally functioning thyroid tissue as a result of the autoimmune disease Hashimoto's thyroiditis, a chronic inflammation of the thyroid. Dry eyes and an impaired tear film production are among the multifaceted symptoms. Patients commonly report

• dry eyes
• burning eyes
• red eyes
• red eyelids
• itchy lid margins
• swelling of the eyelid margins
• sticky discharge on the eyelashes
• encrustations
• foreign body sensation

Since Hashimoto’s thyroiditis leads to hypothyroidism and slows down the metabolism, the production of the tear film can also be affected. The surface of the eye is no longer sufficiently moistened, and inflammation of the eye surface can occur. Many suffer from chronic eyelid margin inflammation (blepharitis) or meibomian gland dysfunction.

First and foremost, the underlying thyroid disease is treated, for example with medicines that balance the hormones. Depending on the severity of the symptoms, various measures can be taken to specifically alleviate eye symptoms:

• moisturising or wetting eye drops: Regular moistening or wetting with eye drops helps dry eyes. If the symptoms are severe, an eye ointment can be applied before going to bed to protect the eyes and keep them healthy overnight.
• Eyelid margin hygiene: In chronic blepharitis or meibomian gland dysfunction, which can be triggered by thyroid disease, consistent eyelid margin hygiene has been shown to remove secretion residues from the eyelid margins and stimulate the function of the sebaceous glands in the eyelid margins.
• Medications: Acute inflammation of the eye or eyelid is treated with anti-inflammatory eye drops or eye ointments.

People who suffer from Hashimoto’s thyroiditis or Graves’ disease often have permanent eye symptoms. In such cases, regular cleaning and care of the eyelids is useful to prevent inflammation and relieve irritation.