Understanding Thyroid Disorders and Their Impact on Eye Health

Around 30% of Indians experience thyroid disorders, with autoimmune thyroid disease (AITD) emerging as a prevalent issue. AITD encompasses a spectrum of conditions, including Hashimoto's thyroiditis and Graves' disease.

Hashimoto's thyroiditis leads to decreased thyroid hormone production, whereas Graves' disease results in excessive thyroid hormone production. Middle-aged women are most commonly affected by these diseases.

In AITD, immune cells produce antibodies (anti-thyroid antibodies) that attack thyroid cells, leading to gland damage. This condition can manifest as either hypo- or hyperthyroidism, potentially causing weight gain or loss.

Recent studies indicate that autoimmune thyroid disease (AITD) may be linked to prolonged vitamin D deficiency, particularly prevalent among Indians due to their darker skin tone. The reduced efficiency of indigenous vitamin D production in the skin heightens susceptibility to deficiency.

This suggests that AITD development may be influenced by prolonged exposure to low vitamin D levels, a factor compounded by the decreased ability of darker skin to synthesize vitamin D from sunlight.

Patients with autoimmune thyroid disease (AITD) often exhibit ocular changes, with up to 96% reporting complaints of dry eyes. Unfortunately, the antibodies that target the thyroid also affect the lacrimal gland, leading to reduced tear production and subsequently dry eyes.

Additionally, hyperthyroid patients may experience eyelid retraction, known as lagophthalmos, which hampers complete eye closure (incomplete blink), resulting in exposure of the eye to dryness. This prolonged exposure can lead to corneal ulceration or infection.

Moreover, these antibodies contribute to inflammation, damage, and blockage of the meibomian glands of the eyelids. These glands produce an oily layer over the tear film, preventing it from evaporating. Damage to both the lacrimal and meibomian glands results in eye dryness, irritation, and eyelid swelling.

Consultation and treatment with an endocrinologist are essential for restoring thyroid hormone levels to normal. However, it's important to note that normalizing hormone levels may not necessarily alleviate dryness or irritation of the eyes.

Therefore, a comprehensive eye examination by an ophthalmologist is crucial to assess the extent of damage to the eyes and eyelids. This examination allows for a thorough evaluation of ocular health and aids in determining the appropriate management strategies to address dryness, irritation, and any associated complications effectively.

While the dryness of the eyes is typically addressed with simple lubricating eye drops, it's common for blockage of the meibomian glands to persist. Therefore, a comprehensive assessment of the structural and functional status of these glands is necessary.

This evaluation can be conducted using lipiview interferometry technology. This advanced technology measures various parameters, including blink rate (both complete and incomplete blinks) of the eyelids, oily layer thickness, and provides a detailed high-definition view of both normal and damaged meibomian glands.

Recent technological advancements in ophthalmology have introduced non-medicinal solutions to address this issue. LipiFlow is a machine designed to deliver thermal pulsation treatment to the meibomian glands. This gentle and synchronized thermal pulsation, applied to both the inner and outer eyelids, effectively alleviates blockages in the meibomian glands, allowing them to resume proper function. As a result, the glands can produce protective oils that help maintain the health of the eye surface.