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The Impact of Graves’ Disease on Dry Eyes

Hi, I’m Dr. Raymond Douglas, in Beverly Hills. For today’s Thyroid Thursday episode, I want to talk to everyone a little bit about the impact of Graves’ disease on dry eye.

One thing that I want people to know, is that patients with thyroid eye disease often have very severe dry eye. And that’s because the disease attacks the gland that produces tears. Additionally, other circumstances, such as radioactive iodine, can also dramatically decrease the tear production. I will show you several slides on how this occurs and the impact of Graves’ disease on dry eyes.

In this illustration, you can see the lacrimal gland and the tear film, of just how that’s formed. The tears are both a fluid, but they also have a fatty layer too that protects them from evaporation. So it’s the quantity of tears that are produced, or actually decreased in Graves’ patients, as well as the quality of tears.

There are several ways of testing for this.  One way to test this is to look at the cornea and to notice if there’s any evidence of little scratches on the cornea. You can do this with a dye, and we can also put a little piece of paper inside the eyelid and test to see how many tears they’re actually producing.

So, once we know if someone with Graves’ eye disease has decreased tears, and if it’s very severe, we can often tailor that, and try to augment that with artificial tears, and various supplements.

What is the effect of radioactive iodine on tear production and tear quality?

One of the things that we’ve seen in the past is that patients with Graves’ disease and patients have larger tear glands. At first, you’d think that, well, a bigger gland means you produce more tears, but actually it’s because there’s extensive scarring in this gland. Unfortunately, the scarring and the autoimmune process destroys a lot of the tear producing cells, and what’s more, is when you have radioactive iodine, the radioactive iodine is actually taken up by these cells, in addition to the thyroid, which it’s aimed at killing, but it’s taken up by the lacrimal gland, and unfortunately reduces the tear production even further.

So in many patients, the tear differences, and what’s happening, is that you’re producing fewer tears if you’ve had radioactive iodine and Graves’ disease. It’s kind of like a double whammy. One way of thinking of that, and planning for that is to take and use artificial tear supplements, and certainly Omega-3 and Omega-6 supplementation.

This often occurs in the lacrimal gland, which is the tear-producing gland, but it can also occur in the salivary gland. So patients who have our radioactive iodine can often get dry mouth too. There are several studies that patients about 30 to 40% of people within the first six months of treatment will have significant problems. So if you’ve just had radioactive iodine, it’s certainly something for you to think about, and to supplement.

Most of the time, this goes away after a year, but it can linger for many patients. So, there’s a variety of evidence but I want you to at least know that the Iodine 131 is taken up by a variety of other tissues, and that this can produce dryness in both the lacrimal gland, and also mouth dryness. It’s something to think about when you’re considering thyroid options.

Contact Dr. Douglas Today!

If you have any additional questions about the impact of Graves’ disease on dry eyes, do not hesitate to contact our office at 310.657.4302.

Posted in: Thyroid Eye Disease

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