About 30% of Indians suffer from thyroid disorders of which autoimmune thyroid disease (AITD) is increasingly a common problem; AITD is a broad spectrum of disease ranging from hashimoto’s thyroiditis to Graves disease. Hashimotos thyroiditis results in low thyroid hormone production while graves disease cause high thyroid Hormone production. Women of middle age are most commonly effected, In these diseases immune cells produce antibodies ( anti thyroid antibody ) against the thyroid cells which subsequently damage the gland, since this condition can cause hypo or hyperthyroidism; weight gain or loss can occur.
Recent research suggests that AITD triggers from long standing Vit D deficiency, Indians are particularly susceptible to Vit D deficiency because of darker skin color that reduces efficiency of indigenous Vit D production in the skin.
The patients with AITD often present with changes in eyes, as high as 96% of patients suffering from AITD present with complain of dry eyes, unfortunately the antibodies that harm thyroid also effects on lacrimal gland resulting in lowered amount of tear production, this gradually results in dry eyes, further; eyelid retraction can occur in hyperthyroid patients causing difficulty in complete closure of eye,(incomplete blink) this condition is called lagophthalmous, the exposed eye gradually dries up and can result in ulceration or infection of the exposed cornea. These antibodies also cause
inflammation, damage and blockage of meibomian glands of eyelids, meibomian glands produce a oily layer over the tear film and protect the tear film from drying up and thus overall damage to lacrimal gland and meibomian gland result in dryness and irritation of eyes along with swelling of eyelids.
A consultation and treatment with an endocrinologist is needed for bringing thyroid hormone to normal levels, however; normalising hormone does not alleviate dryness or irritation of the eyes, a thorough eye examination with an ophthalmologist is needed to evaluate the damage over eyes and eyelids.
The dryness of the eyes are usually tested and treated with simple lubricating eye drops, however; often blockade of meibomian glands are not entirely resolved. A thorough evaluation of structural and functional status of meiobian gland is needed, this can be evaluated through lipiview interferometry technology. The machine measures the blink rate(complete and incomplete blink) of eyelid, oily layer thickness and detailed HD view of normal and damaged meibomian glands.
Recent technological advancements in ophthalmology have addressed this problem through non-medicinal approach, lipiflow is a machine that delivers a thermal pulsation treatment to the meibion glands, the gentle synchronised thermal pulsation over inner and outer eyelid effectively relieves the blockage of meibiomian gland allowing them to function properly and produce protective oils over eye surface.
Dr. Bhanu Prakash Metukul, M.S, FICO, Fellow (Cornea), FAICO (Refractive Surgery) Senior Consultant Maxivision Super Specialty Eye Hospitals.