In addition to these important contributions, it is helpful to understand, some of the possible triggers for your condition, as this may help lead to a solution. The thyroid can misbehave in a number ways. In some cases, the condition can lead to a wider opening between the eyelids and less complete lid closure on blinking. This causes an "exposure" problem. When the ocular surface is "exposed", typically the protective tear layers evaporate between blinks leaving the ocular surface dry and irritated. The grittiness can then arise from a number of places. 1. the lid wiper: which is a thin pad of eye lid tissue under the upper eyelid which contacts the ocular surface with each blink and 2. the edges of the eyelids: one of the casualties of thyroid eye problems is secondary inflammation on the edges of the eye lids. If the ocular surface is dried out enough and for long enough the eyelids' meibomian glands can become compromised. Tear science is complex, but basically, there are three primary tear layers and they work together. So if the watery tears are drying out, then the oily tears which come from little glands in the eye lids will block up and fail to produce good oils, and this also contributes to the grittiness.
Another problem with thyroid dysfunction, is its possible effect on watery tear production. Just as the oily part of our tears comes from our eyelids, the watery part called "aqueous" comes from the lacrimal gland, which sits approximately behind the eyebrow. If tear production in this gland is compromised it can have an effect on the volume of tears that make it to ocular surface.
The reason I draw this distinction, is because specialists in dry eye disease, manage these two causes differently. Here at the Dry Eye Centre, we work to differentiate the exact cause(s) of the thyroid problem and then put a treatment strategy in place which we closely monitor. Lubricating eye drops may provide some benefit, but more often than not we see patients, often years down the track , following thyroid treatment, with persistent dry eye problems.
Of course, it's possible that the grittiness has nothing to do with the thyroid and is just coincidental with a thyroid problem. In this case you would require a diagnostic evalation to really understand it. Therefore, my suggestion would be to seek professional assistance from an eye care professional who specialises in dry eye, or call us at The Dry Eye Centre and ensure that you know what's causing it!
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