Any hyperthyroid patient, no matter what causes their hyperthyroidism, may experience elevation of the upper eyelid anytime the blood level of thyroid hormone is above normal. For example, patients who are hyperthyroid because of too much thyroid hormone medication may have raised upper eyelids causing their eyes to appear enlarged or staring. In this situation, however, the eyes do not actually protrude.
If you have Graves' disease, you may develop protrusion and inflammation of your eyes without there being any evidence of infection. It is likely to begin about the time your thyroid becomes overactive, but it may precede your hyperthyroidism or occur years after your thyroid function has become normal. Very rarely, the eye disorder may occur without your having any obvious abnormality of thyroid function at any time in your life.
More serious eye problems may occur in patients with Graves' disease and (less commonly) Hashimoto's thyroiditis. The severity of these conditions is unrelated to the blood level of thyroid hormone. If the condition is mild, you may have only redness and irritation of your eyes. On the other hand, in those rare instances when the inflammation is more severe your eyes may protrude, you may have double vision, and your sight may be threatened.
It should be pointed out that the thyroid eye disease does not necessarily progress in an orderly fashion from mild to severe in any given patient. In fact, a rapid decrease in vision can occur due to pressure upon the optic nerve in a patient with only minimal swelling of the eyelids. For this reason, if you have Graves' disease and begin to show signs of eye trouble, you should have a complete eye examination. If your eye involvement is severe, your physician may refer you to an ophthalmologist (eye specialist), who will have at his/her disposal all of the equipment needed to evaluate the various eye problems that may occur in Graves' disease. Your vision can be accurately tested. The amount of eye protrusion can be accurately measured with an exophthalmometer. The cornea and other tissues of your eye can be examined by the use of a microscope-like instrument known as a slit lamp. Ultrasound pictures of your eye and eye socket (orbit) may be taken, using sound waves in a technique similar to radar. Alternatively, your physician may request special x-rays of your orbits done by computerized tomography (CT scan) or by a newer technique called Magnetic Resonance Imaging (MRI). These techniques will provide a clear picture of the inflamed tissues behind your eye.
Treatment of your eye condition will depend upon the kind of eye disease you have and whether it is getting worse. Mild inflammation may be treated simply by elevating the head of your bed at night and by lubricating your eyes with drops of "artificial tears." On the other hand, if you have a severe and rapidly progressive inflammatory condition with double vision or decreased vision, you may require special glasses or treatment with steroids. If your eye tissues continue to swell despite the use of steroid hormones, additional therapy is available. This may include x-ray treatments to the tissues behind the eye or surgery on the bony orbit (surgical decompression) to relieve the increased pressure behind your eye.
New research suggests that cigarette smokers are at greater risk for these troubles than non-smokers, so if you smoke and have just developed Graves' disease, stop smoking at once. Fortunately, serious eye problems are rare among thyroid patients. When they do occur, the treatment methods are excellent and are usually successful in improving the problem. Occasionally excessive drooping of the upper or lower eyelids may cause cosmetic problems, but plastic eye surgery can be very helpful for such patients.