Jorge G. Camara, M. D.

Patients with hyperthyroidism (overactive thyroid) frequently develop eye symptoms that can lead to serious eye problems if not diagnosed and treated promptly. The combination of an overactive thyroid gland and related eye problems is also known medically as Graves’ Ophthalmopathy.

Although the exact cause of Graves’ Ophthalmopathy is not known, it is believed that the body’s immune system attacks the tissues located within the socket of the eye (orbit) such as the eye muscles, the lacrimal (tear) gland, and the protective cushion of fat surrounding the eyes. Furthermore, there is increased stimulation of the nerves that hold the lid open (lid retraction) giving rise to the common staring appearance of patients with hyperthyroidism.

Patient with hyperthyroidism showing thyroid stare.

Due to the body’s immune system attacking the tissues within the orbit, there is an inflammatory reaction that causes symptoms ranging from dryness of the eye, to marked discomfort, eye pain, double vision, and in severe cases, to loss of vision which can be permanent. The eyelid retraction, combined with the bulging forward of the eyes, leads to inability to close the eyes fully. The front surface of the eye (cornea) then becomes extremely dry, and can become ulcerated and infected, leading to loss of sight.

Patient with inability to close eyes leading to corneal ulcer.

The enlargement of the eye muscles in Graves’ Ophthalmopathy causes double vision especially when looking upwards. This symptom can be especially bothersome when reading, or driving a car. The eyes can bulge forward so badly that pressure on the optic nerve (nerve of sight) can reduce one’s vision to legally blind levels, unless immediate treatment is undertaken.


In mild cases, treatment of thyroid eye disease is mainly supportive. Artificial tears in a form of drops are applied during the day, and ointment is administered in the evening before sleeping. If the eyes do not shut fully due to lid retraction, they are taped shut after applying lubricating ointment.

In more severe cases where there is marked swelling of the tissues in the socket of the eye, steroid medications (prednisone) are given my mouth to control the inflammation. Radiation treatment may also be given to decrease the swelling in the orbit.

The double vision and eyelid retraction are usually corrected with surgery, if they fail to resolve with improvement of the thyroid function. Shown in the photograph below is a patient before and after surgery for severe eyelid retraction.

Patient before lid surgery Same patient after surgery

The most serious eye complication of hyperthyroidism is a condition called thyroid optic neuropathy which is caused by pressure on the optic nerve causing moderate to severe loss of eyesight. The loss of sight may be subtle, only causing a change in perception of color, to complete loss of eyesight. Treatment should be administered as soon as possible, usually consisting of steroids given by mouth.

If the vision fails to improve then surgery is necessary to relieve the pressure surrounding the optic nerve. The surgery consists of removing the bones in the innermost part of the orbit where the pressure on the nerve is the greatest. This surgery is called an orbital decompression. In some medical centers, radiation treatment is used instead of surgery. However, the complications of radiation treatment, while rare, can cause worse problems than thyroid optic neuropathy itself.

Female patient before orbital decompression Female patient after orbital decompression
Male patient before orbital decompression Male patient after orbital decompression

In summary, it is important to be aware of the signs and symptoms of thyroid eye disease, and to see an ophthalmologist immediately should any of them occur. Techniques in modern day ophthalmic plastic and reconstructive surgery can take care of the eye problems that arise as a result of hyperthyroidism.

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Diabetes and Hormone Center of the Pacific
Ala Moana Pacific Center
Ala Moana Pacific Center
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Honolulu, Hawaii 96814
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