The Case:  Jane has been experiencing dry, irritated eyes for the past 2 years She’s treated them with steroid drops and antihistamines but the problem persists After consulting many doctors and taking tests, there seem to be no answers.    Eye irritations can range from dry, itchy eyes to puffiness. Most people reach for over-the-counter eye drops or antihistamines for temporary relief. If it’s caused by the environment or allergies, this might solve the issue but when it persists - there may be a bigger issue at play.    The Investigation My sense was that another organ was driving her eye issues. I suspected that it actually wasn’t  an eye issue, so to solve this health mystery, we had to look outside the box. And, I knew just who to contact, Dr. Rudrani Banik (Dr. Rani). She’s a board-certified and fellowship-trained Neuro-Ophthalmologist with a functional medicine approach. You may remember her, she was on episode 50.  Dr. Rani confirmed that eye issues aren’t always just about the eyes.    The Eye Thyroid Connection The thyroid is related to the health of your eyes. The receptors on the thyroid look very similar to the receptors that are found on the connective tissue in the eye socket. When there are issues with the thyroid, specifically autoimmune issues, there is the possibility that the eyes can be affected. There are a lot of different eye issues that are related to either Graves Disease or Hashimoto’s (autoimmune issues related to the thyroid).  However, sometimes the eye issues present before the autoimmune issue is detected or diagnosed making the connection difficult to make.    Symptoms of Thyroid Eye Disease The symptoms of thyroid eye issues can start out like many eye issues. For example, you might have dryness, irritation, redness, puffiness or swollen lids. The usual course of action for these symptoms might be to use drops (including over the counter and steroid gel drops), antihistamines or both but if these don’t work, these may be symptoms of thyroid eye disease.  Additional characteristics of thyroid eye disease may include the swelling or puffiness of the upper eyelids especially in the morning with the swelling decreasing through the day. Other symptoms may include chronic redness or a shift in the width of the eye socket. The latter may result in the eyes appearing bigger or wider. There may even be some inflammation causing the eyes to protrude or bulge (proptosis).  If left undiagnosed and untreated, the muscles behind the eye socket can get involved and cause double vision and even vision loss. Note that this does not happen overnight - it’s a severe advancement of the condition but it’s worth noting what can happen if the situation is not dealt with.    Diagnosing Thyroid Eye Disease The most important part of tying an eye issue to the thyroid is to get blood tests.  But, it’s not enough to just test the TSH or T3 as many doctors will do as a thyroid test. Dr. Rani says she likes to get the full antibody panel including TPO (thyroid peroxidase), Tg (thyroglobulin  antibodies), and TSH (thyroid-stimulating hormone) receptor (which tends to be elevated in thyroid eye disease patients).    Dr. Rani also says an eye exam is very important. She measures the lids very carefully to see if they are more open. She also tracks this over time to watch for changes. She’s also looking for congestion in the eye socket, asks about double vision, and checks the ocular motility.  Finally she uses an exophthalmometer to determine how the eye rests within the socket. Sometimes a CAT scan or MRI are required.    Treatment of Thyroid Eye Disease Once the issue has been properly diagnosed, there are several things that can be done to help treat thyroid eye disease including:     Eye Lubrication    Treating eye redness, dryness, and irritation can be done with topical medications (typically drops or ointments). Sometimes patients require medications (antihistamines or topical steroids but Dr. Rani only uses ster