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Betty Davis Eyes… (Part I)

© Keri

Bulging, staring eyes have long been associated with Graves' disease, an autoimmune form of hyperthyroidism. Thyroid Eye Disease or TED is one of the clinical names for the problem. It is also known as Graves Eye Disease (GED), Graves opthalmopathy, or endocrine orbitopathy. It is thought to be the result of the same autoimmune antibodies that attack the thyroid also attacking the soft tissues of the eye. Symptoms can range from minimal to severe.

TED may occur in up to 90% of people with Graves, but only 50% or less have visible symptoms. Less than 20% of those will have severe symptoms that require aggressive treatment. Like thyroid disease it is more common in women, however, the symptoms are usually more severe in men and older persons.

Like so much else with autoimmune thyroid disease, there are no absolutes. While TED is associated with Graves' disease, it can also occur in individuals with Hashimotos thyroiditis and low to normal thyroid levels. TED can occur simultaneously with the diagnosis of thyroid disease or even months or years after treatment of the underlying disease. People with Graves can have normal thyroid levels and develop TED.

TED effects eye tissue in three ways:

Inflammation of the conjunctiva (the clear covering of the eye and the inner eye lids) can produce redness, swelling, the sensation of grit or sand in the eye, increased tearing or watery eyes, and swelling around the eye

Swelling of fatty tissue around the eyes may produce the protrusion and bulging (the bug-eyed effect)

Inflammation and swelling of one or more of the four small muscles that move the eye may result in loss of muscle function causing eye pain and double vision.

Many people with TED have a staring gaze due to retraction (pulling back) of the upper eyelid. This causes a band of the white part of the eye to show above the cornea (colored part of the eye) giving a wide-eyed staring effect. Damage can occur to the cornea if the eyelids do not close completely, especially during sleep. If the cornea dries, it can become infected or even perforate (get a hole in it). This could lead to loss of vision or even the loss of the eye if not treated.

In our next article, we will explore the common symptoms of TED and the suggested treatments.

For more information:

National Graves Disease Foundation
Thyroid Disease and the Eye
The Thyroid Solution by Ridha Arem,MD

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