Mild Disease
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Eye Symptoms
Hyperthyroidism usually causes eye dryness and irritation. It is important to distinguish these symptoms from Graves’ ophthalmology, which almost exclusively occurs in those patients who have Graves’ disease (rare exceptions include Hashimoto’s thyroiditis, primary hypothyroidism, and thyroid cancer). It may be difficult to distinguish between eye symptoms due to hyperthyroidism and those due to Graves’ antibodies. Sometimes the two coincide.
A number of patients with hyperthyroidism have lid retraction, resulting in stare and lid lag due to contraction of the levator muscles. This stare sometimes appears as if a patient has protruding eyeballs, although proptosis doesn’t actually exist. This condition lessens when hyperthyroidism is treated.
Graves’ is associated with inflammation of the extraocular muscles, orbital fat and connective tissue. This results in a number of upsetting symptoms. Most frequently, a patient will present with protruding eyeballs and conjunctival/corneal irritation. Such irritation includes burning, tearing, pain, photophobia, and the feeling of sand/grit in their eyeballs. Double vision may be experienced. Some patients complain of limitations in eye movement due to poor muscle function. Others notice edema/swelling and accumulation of fluid beneath the skin around the eyes. Thickening of skin in the lower extremities, known as Infiltrative dermopathy, may also be experienced. In rare cases, the optic nerve may be compressed resulting in vision impairment/loss.
Due to Hyperthyroidism
If patients do not exhibit Graves’ ophthalmopathy, it is possible they show other ophthalmic signs due to hyperthyroidism. These include: dry eyes given lack of corneal moisture, irritation, discomfort, or pain in the eyes, tingling sensation behind the eyes, a feeling of grit/sand in the eyes, and/or excessive tearing. In addition, they may exhibit swelling/redness of the eyes, lid lag, light sensitivity, blurred vision, infrequent blinking, lid retraction, or widened palpebral fissures.
