LASIK can be performed in patients with hyperthyroidism or hypothyroidism but only careful attention to dry eye issues.

A patient from Santa Maria recently asked me if LASIK can be performed on people with thyroid problems. The answer is a qualified yes, as long as careful attention and consideration is given to dry eye issues. Some thyroid eye disease patients are not candidates for LASIK or PRK, however.

I have performed LASIK on hundreds of patients with thyroid disease over the years with excellent outcomes — but only after careful preoperative screening. Of course, there are several types of thyroid problems. It is important to keep in mind that having thyroid problems is not necessarily the same as having true “thyroid eye disease”. In general, though, the main consideration in thyroid disease is dry eye — and some patients with thyroid disease have eyes that do not respond well to medical treatment for dry eyes and therefore are not good candidates for surgery. Interestingly, many thyroid problems are autoimmune diseases in which the body’s immune system attacks both the eyes and the thyroid.

In the case of Graves Disease (or “thyroid eye disease”), the main underlying problem causing dry eye is incomplete eye lid closure due to proptosis — the tendency of the eye to protrude outward and the eyelids to be retracted back in this autoimmune condition. If a patient’s eyelid closure is inadequate to completely cover his or her eye, this person would not be a good candidate for LASIK or PRK laser eye surgery as both procedures require good blinking and spreading of tears on to the surface of the eye. In general, patients with true thyroid eye disease should be approached with great caution when considering laser vision correction surgery and usually are not optimal candidates.

Beside the mechanical basis for dry eye seen in patients with thyroid eye disease due to the inability of the lids to adequately wet the eye, dry eye in systemic thyroid disease such as hypothyroidism or hyperthyroidism also can be from a direct autoimmune effect on tear production in which the body’s immune system attacks the lacrimal glad, which is the gland that makes the watery layer of the tears. Additionally, thyroid hormone itself — the hormone that is produced by the thyroid gland –can be found at abnormal levels in the blood in patients with thyroid disease. Beside regulating many metabolic and biochemical systems in the body, thyroid hormone is involved in regulating the production of the oil layer of the tears by the meibomian glands in the eyelid. If thyroid hormone levels are abnormal due to thyroid disease, this could disturb the oil layer and make tears more prone to evaporation, producing “evaporative dry eye.”

Patients with thyroid disease need to treated successfully for dry eye syndrome both before and after their LASIK or PRK laser vision correction eye surgery. Restasis can work very well on some of these patients as it suppresses chronic inflammation produced by autoimmune thyroid disease affecting the surface of the eye. Oral omega three supplements and topical Azasite drops can help improve the oil layer of the tears. Some patients with an inadequate watery layer of the tears (inadequate tear volume) can benefit from punctal plugs before and after laser eye surgery. If dry eye can be successfully controlled and there is no evidence of true thyroid eye disease with proptosis and lid involvement, many of these patients with thyroid problems otherwise can have LASIK.

Some patients with advanced Graves Disease and thyroid ophthalmopathy (protrusion of the eye, retraction of the lids) can benefit from plastic surgery to improve lid function, but generally these patients are not good candidates for LASIK or PRK.

If careful attention to dry eye is made at the time of surgery, patients with thyroid disease can enjoy excellent results after LASIK or PRK if there is no evidence of true thyroid eye disease with proptosis and lid retraction. However, whether or not surgery is performed, patients with chronic thyroid disease need to know their eyes still could become more dry over time due to the underlying autoimmune nature of thyroid disease.

In general, the decision to have LASIK should be approached carefully in patients with thyroid disease.

See Also

LASIK in Thyroid Eye Disease
An article from the European Society of Cataract and Refractive Surgery discussing the caution with which thryoid eye disease patients must be approached when considering LASIK.

What is Grave’s Disease
A discussion by the American Thyroid Association about Grave’s Disease and Thyroid Eye Disease.

Hashimoto’s Disease
A discussion from the Mayo Clinic regarding Hashimoto’s Disease.

Facts About Dry Eye
National Institutes of Health’s National Eye Institute discussion of dry eye syndrome.

For Severe Dry Eye, Are There Alternatives to Restasis?
AARP discussion of the role of Restasis in treating dry eye syndrome.

Restasis: Getting Beyond the Dry Eye Facts
American Society of Cataract and Refractive Surgery publication about Restasis and dry eye management.