Dr. Ankita Patil

Thyroid Eye Disease

What are the signs and symptoms of thyroid eye disease?

The signs and symptoms of thyroid eye disease include:

  • Dry eyes.
  • Irritated eyes due to a gritty feeling.
  • Watery eyes.
  • Red eyes.
  • Bulging eyes, also called proptosis.
  • A “stare.”
  • Double vision, also called diplopia.
  • Difficulty closing your eyes completely. This can lead to an ulcer (sore) on your cornea.
  • Vision.
  • Pain behind your eyes and pain with eye movements.

Symptoms normally affect both eyes, but sometimes you may only notice symptoms in one eye.

Is thyroid eye disease contagious?

No. Thyroid eye disease isn’t contagious. You can’t catch it from anyone, and you can’t transmit it to anyone.

What tests will be done to diagnose thyroid eye disease?

A healthcare provider will be able to diagnose thyroid eye disease by doing a physical eye exam. They will be able to examine both your eyelids and your eyes.

If your healthcare provider thinks that you have thyroid eye disease, they’ll order blood tests to check if your thyroid hormone levels and antibodies are too high or too low.

Other tests your provider may request include:

  • Ultrasound of the eyes.
  • Computed tomography (CT).
  • Magnetic resonance imaging.


Symptoms of Ptosis

The most obvious sign of ptosis is drooping of the eyelid. Other symptoms include:

  • Difficulty closing the eye or blinking
  • Tearing
  • Eye fatigue
  • Trouble seeing (because of this, a person may tilt their head back in order to see under the eyelid)

Children with ptosis may have additional symptoms, such as:

  • Amblyopia, sometimes called lazy eye because one eye seems to look off in another direction3
  • Nearsightedness, farsightedness, or astigmatism
  • Double, blurred, or distorted vision
  • Eye strain, headaches, or dizziness.

Causes and Risk Factors

In adults, ptosis is often caused by normal aging. Aging can cause the eyelid muscles (called levator muscles) to weaken.

Sometimes people are born with ptosis. This is called congenital ptosis. Congenital ptosis may be caused by problems with the brain or nerves that lead to weakness in the eyelid muscles. Children born with a birth defect or injury that affects the eyes may also have ptosis.

People with eye tumors, diabetes, a history of stroke, cancer, and neurological disorders are at risk for developing ptosis.

Cosmetic treatment with Botox (botulinum toxin A) can sometimes cause ptosis. If you are interested in getting Botox treatments, make sure to find an experienced practitioner.



Normally when you blink, your eyelids distribute tears evenly across your eyes, keeping the surfaces of the eyes lubricated. These tears drain into small openings on the inner part of your eyelids (puncta).

If you have ectropion, your lower lid pulls away from your eye and tears don’t drain properly into the puncta. The resulting signs and symptoms can include:

  • Watery eyes (excessive tearing). Without proper drainage, your tears may pool and constantly flow over your eyelids.
  • Excessive dryness. Ectropion can cause your eyes to feel dry, gritty and sandy.
  • Irritation. Stagnant tears or dryness can irritate your eyes, causing a burning sensation and redness in your eyelids and the whites of your eyes.
  • Sensitivity to light. Stagnant tears or dry eyes can irritate the surface of the cornea, making you sensitive to light.

When to see a doctor

See your doctor if your eyes are constantly watering or irritated, or your eyelid seems to be sagging or drooping.

Seek immediate care if you have been diagnosed with ectropion and you experience:

  • Rapidly increasing redness in your eyes
  • Sensitivity to light
  • Decreasing vision

These are signs and symptoms of cornea exposure or ulcers, which can harm your vision.


Ectropion can be caused by:

  • Muscle weakness. As you age, the muscles under your eyes tend to weaken, and tendons stretch out. These muscles and tendons hold your eyelid taut against your eye. When they weaken, your eyelid can begin to droop.
  • Facial paralysis. Certain conditions, such as Bell’s palsy, and certain types of tumors can paralyze facial nerves and muscles. Facial paralysis that affects eyelid muscles can lead to ectropion.
  • Scars or previous surgeries. Skin that has been damaged by burns or trauma, such as a dog bite, can affect the way that your eyelid rests against your eye. Previous eyelid surgery (blepharoplasty) can cause ectropion, particularly if a considerable amount of skin was removed from the eyelid at the time of surgery.
  • Eyelid growths. Benign or cancerous growths on your eyelid can cause the lid to turn outward.
  • Genetic disorders. Rarely is ectropion present at birth (congenital). When it is, it’s usually associated with genetic disorders, such as Down syndrome.

Risk factors

Factors that increase your risk of developing ectropion include:

  • Age. The most common cause of ectropion is weakening muscle tissue associated with aging.
  • Previous eye surgeries. People who have had eyelid surgery are at higher risk of developing ectropion later.
  • Previous cancer, burns or trauma. If you’ve had spots of skin cancer on your face, facial burns or trauma, you’re at higher risk of developing ectropion.



The signs and symptoms of entropion result from the friction of your eyelashes and outer eyelid against the surface of your eye. You may experience:

  • The feeling that something is in your eye
  • Eye redness
  • Eye irritation or pain
  • Sensitivity to light and wind
  • Watery eyes (excessive tearing)
  • Mucous discharge and eyelid crusting

When to see a doctor

Seek immediate care if you have received a diagnosis of entropion and you experience:

  • Rapidly increasing redness in your eyes
  • Pain
  • Sensitivity to light
  • Decreasing vision

These are signs and symptoms of cornea injury, which can harm your vision.

Make an appointment to see your doctor if you feel like you constantly have something in your eye or you notice that some of your eyelashes seem to be turning in toward your eye. If you leave entropion untreated for too long, it can cause permanent damage to your eye. Start using artificial tears and eye-lubricating ointments to protect your eye before your appointment.


Entropion can be caused by:

  • Muscle weakness. As you age, the muscles under your eyes tend to weaken, and the tendons stretch out. This is the most common cause of entropion.
  • Scars or previous surgeries. Skin scarred by chemical burns, trauma or surgery can distort the normal curve of the eyelid.
  • Eye infection. An eye infection called trachoma is common in many developing countries of Africa, Asia, Latin America, the Middle East and Pacific Islands. It can cause scarring of the inner eyelid, leading to entropion and even blindness.
  • Inflammation. An irritation of the eye caused by dryness or inflammation can lead you to try to relieve the symptoms by rubbing the eyelids or squeezing them shut. This can lead to a spasm of the eyelid muscles and a rolling of the edge of the lid inward against the cornea (spastic entropion).
  • Developmental complication. When entropion is present at birth (congenital), it may be caused by an extra fold of skin on the eyelid that causes turned-in eyelashes.

Risk factors

Factors that increase your risk of developing entropion include:

  • Age. The older you are, the greater your chances of developing the condition.
  • Previous burns or trauma. If you’ve had a burn or other injury on your face, the resulting scar tissue may put you at higher risk of developing entropion.
  • Trachoma infection. Because trachoma can scar the inner eyelids, people who have had this infection are more likely to develop entropion.