I suspect a good number of us have had some level of dry eyes when hypothyroid. Seems to be a reasonably well-known sign, though all too often dismissed or ignored. And if any treatment is thought about, it will be purely symptom relief.
I certainly had not set my mind in the direction of asking why we might get dry eyes. So it came as a bit of a surprise to see this paper which suggests one factor which might explain what happens. Obviously we also need to understand why it happens…
As so often a tiny cohort of subjects. Pretty much at the level usually dismissed a anecdotal. Still, once someone has said something, others might pick it up and run further.
Clin Ophthalmol. 2019; 13: 131–135.
Published online 2019 Jan 7. doi: 10.2147/OPTH.S188614
PMCID: PMC6327900
PMID: 30662256
Assessment of tear-evaporation rate in thyroid-gland patients
Ali Abusharaha,1 Abdulaziz A Alturki,1 Saud A Alanazi,1 Raied Fagehi,1 Naji Al-Johani,2 Gamal A El-Hiti,1 and Ali M Masmali1
Author information Copyright and License information Disclaimer
1Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia, as.ude.usk@ahrahsubaa
2Department of Endocrinology and Thyroid Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh 11433, Saudi Arabia
Objective
To assess the tear-evaporation rate in thyroid-gland patients using a VapoMeter.
Methods
Twenty thyroid gland patients aged 18–43 years (mean 34.3±6.3 years) completed the study. Additionally, an age-matched control group of 20 patients aged 18–43 years (32.2±5.1 years) was enrolled in the study for comparison purposes. An Ocular Surface Disease Index dry-eye questionnaire was completed, followed by a test to determine the tear-evaporation rate using the VapoMeter. The test was performed three times per subject by the same examiner. Two readings were obtained each time.
Results
Significant differences (P<0.05) were found between mean Ocular Surface Disease Index and tear-evaporation-rate scores within the study and control groups. The average tear-evaporation rate was much higher in the study group (median 41.2 [IQR 41.4] g/m2⋅h) than the control group (15.7 [13.7] g/m2⋅h). Moreover, the average Ocular Surface Disease Index score for thyroid-gland patients was much higher (15.6 [23.4]) compared to the control group (5.5 [7.50]).
Conclusion
The tear-evaporation rate in thyroid-gland patients was found to be much higher than normal-eye subjects.
I have dry eyes and was using a heated eye bag every day together with massaging the tear glands, to unblock them, then cleansing with Blephasol liquid, as recommended by my (knowledgeable) optician. However...this only just about kept the problem at bay. What has had a remarkable effect though in the last 6 weeks is not adding in T3 (which I started over 6 months ago) but taking a tablespoon of flaxseed daily. I’d researched alternative therapies for dry eyes and this came up. I’m now only having to use the heated eye bag once a week and, t o boot, my swollen stiff knuckles feel a bit better too. X
As written below, my eyes seem worse when I feel more hypo. One symptom of hypothyroidism is thickened and flaky skin. That must include the eyelids!!!
Once I had been on T3 about a year or so this issue pretty much went away. I had also started with all the supplementation a year ahead of that. Very interesting.
Very interesting article, I hope someone does further research and comes up with some solutions or advice on how best to manage dry eyes in hypothyroidism.
I believe that swelling in hypothyroidism occurs for the same reason as everywhere else - mucin. But in hyperthyroidism it might be rather more complex - I don't recall a satisfactory explanation for the proptosis of Graves/thyroid eye disease.
They've pretty stayed the same for the last few years... but still, not a nice feeling when so much goes wrong. The dry mouth is horrific - then OLP (on top of everything else), eek - feel like I'm being invaded by the 'Body Snatchers'. Take care and be well
I don't know that I have dry eye, because I describe mine as sticky; but I wonder if that's also what others feel with what they label dry eye. When I had my eyes lazered some years ago, I was told the stickiness was the result of having a high level of proteins around the eye, but can't remember more than that. This stickiness is the same experience as that using soft contact lenses before the lazering, so perhaps it was me/my thyroid rather than the contact lenses, all along, and the lenses were blameless
So, it seems there are 491 proteins - "Identification of 491 proteins in the tear fluid proteome reveals a large number of proteases and protease inhibitors." Gustavo A de Souza, Lyris MF Godoy, Matthias Mann 2006
"The tear film is a thin layer of fluid that covers the ocular surface and is involved in lubrication and protection of the eye. Little is known about the protein composition of tear fluid but its deregulation is associated with disease states, such as diabetic dry eyes. This makes this body fluid an interesting candidate for in-depth proteomic analysis. ...... Identification of a large set of proteins participating in these reactions may allow discovery of molecular markers of disease conditions of the eye".
Helvella, THANK YOU! I am so grateful for this it had me literally in tears!
In December I had an eye test because my vision seemed to be getting slightly blurred. I have slight cataracts, but still legally OK to drive. The optometrist had a good look at my eyes and said I had blepharitis. I asked if it was anything to do with the thyroid trouble and she said no. So just another "Getting old" inconvenience. Fair enough.
However, I noticed that my eyes seemed worse when my hypo symptoms were worse.
Then, at the beginning of this month my Levo was reduced because my TSH was "Rock bottom", though T4 still within range (no T3 tested of course - not ever!). I was disappointed and frustrated because of thinking I would need an increase, not a decrease. I was told that what I thought were hypo symptoms were actually "Hyper" symptoms because symptoms do overlap.
And then this thread!!!!! Helvella, if you lived near I would come and hug you!!!!!
Thank you for posting an interesting paper. There’s a lot more to tears than meets the eye, if you’ll excuse the pun. I even got double vision like two closely superimposed images and dreadful star bursts around any lights especially at night. No one paid the slightest attention to it not even the opticians. I was advised to use drops some time later and investigated for myasthenia gravis - inconclusive. Mine are still very dry, the drops help a bit but I wonder why the dryness still persists.
Thank you for sharing this article. I have been dealing with loss of reflex tearing and surface dry eye for a few years. I am always searching for a connection between my Hashimoto’s and dry eye. I will add this research study to the conversation as I found it helpful: Presence of Dry Eye in Patients with Hashimoto’s Thyroiditis:
I was diagnosed with dry eye by optician. She suggested I start immediately with drops. I was blown away. Had not an iota. Thanks for posting. Another pesky symptom.
It's interesting that both hypo and hyperthyroidism cause this disorder, but apparently for different reasons.
I wonder if there is yet another reason for the same kind of symptoms in diabetics?
Either way, it's an uncomfortable and inconvenient condition!
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