Because thyroid eye disease (TED) affects the eyes, it is no surprise that eye complications are common in TED. One complication is a corneal ulcer.
The cornea and tears
Your cornea is a clear layer of tissue that lines the front of your eye. The cornea protects and refracts (bends) light for normal vision. The cornea also has many nerves that send pain signals to the brain.1
Your tears are made up of the perfect mix of oil on water, held onto the surface of your eye by mucus. When you blink, the tears are washed over the cornea, smoothing its rough surface. If you cannot blink properly, the surface of your eyes is not moisturized and replenished. This leads to a rough outer layer, which can lead to injury and problems with vision.1
What is a corneal ulcer?
An open sore on the cornea is called a corneal ulcer. A corneal ulcer can occur with or without infection. Minor injury, wearing contact lenses too long, or something in your eye (foreign body) can lead to a corneal ulcer.2
TED and corneal ulcer
If you have TED and the swelling makes it hard for you to close your eyes, you are at risk of developing a corneal ulcer. The protective and refreshing jobs of your eyelids are impaired by TED, increasing the risk of injury to the outer surface of your eye.3
Symptoms
Depending on the severity, symptoms of corneal ulcers may vary and include:2
- Eye pain and redness
- An excessive amount of tears or watery eyes
- Blurred or decreased vision
- Pain or sensitivity to light (photophobia)
- Difficulty opening your eyelid
- A gritty feeling or feeling like something is in your eye
Diagnosis
Your TED specialist or ophthalmologist diagnoses corneal ulcers. Your doctor will do several tests to determine the cause and severity of the ulcer. Some of these include:
Slit lamp exam
A slit lamp is a microscope with a bright light. Your TED specialist uses this to see the parts of your eye up close. This device is key to assessing the overall health of your eye and the severity of inflammation.4,5
Diagnostic dyes
Diagnostic dyes are used to see if there is damaged tissue on the surface of your eye. Your TED specialist will place dye eye drops in your eye or will paint the surface of your eye with test strips containing the dye. After staining, your doctor will use the slit lamp to see areas of damage on the surface of your eye.6
Biopsy
If your doctor thinks the corneal ulcer is caused by an infection, they may take a tiny piece of tissue (biopsy). Taking a biopsy can help your doctor identify and properly treat the infection.4
Treatment
Seeing your TED specialist right away when you suspect a corneal ulcer is important to avoid serious vision complications.
Treatment varies depending on the cause of the ulcer. If the ulcer is caused by injury without infection, artificial tear eye drops may be the only treatment needed. However, if you have significant pain and impaired vision, you may need to patch the affected eye for some time and use different eye solutions to heal the ulcer.4
Various eye drops may be prescribed depending on the root cause of the ulcer. There are many different types, and your doctor will decide which is best for you.4
Seeing your TED specialist or ophthalmologist is the first step. Then, be prepared to answer questions about how your symptoms started, your pain level, and other questions related to your medical history and lifestyle.