Thyroid eye disease, eye bulging and double vision: causes and treatment

Many thyroid patients go from doctor to doctor because of bulging eyes, without understanding how the thyroid causes the bulging or how the resulting double vision is treated.

How does the thyroid cause eye bulging?

The immune system treats the tissues of the eye orbit as if they were thyroid tissue and attacks them. Fluid and tissue build up inside the orbit, causing:

• Eye bulging: the eye is pushed forward.
• Double vision: because the eye muscles enlarge.
• Eyelid swelling.
• Pressure on the optic nerve: the nerve runs through the orbit, so fluid or raised pressure inside the orbit can press on it and affect vision.

Treatment

Dr. Mahmoud El Samkary explains the steps:

1. Controlling thyroid hormones with the endocrinologist, which is the essential step.
2. Avoiding stress and smoking, two of the most important triggers of thyroid imbalance.
3. Calming the immune system with cortisone as recommended by the endocrinologist or treating doctor, until the bulging improves.
4. Surgery: if the bulging does not improve and is significant, or affects the cornea or the optic nerve, orbital decompression is performed to return the eye to its normal position.

Treating double vision after surgery

Muscle enlargement may persist after surgery. It is treated with local cortisone injections into the orbit as recommended by the treating doctor, or with prism glasses.

Can bulging return after surgery?

Bulging returns if the underlying cause is not treated. Dr. Mahmoud El Samkary therefore stresses that controlling thyroid hormones and avoiding stress and smoking are the basis of successful treatment.