Wednesday, September 26, 2007
She's got Bette Davis eyes...
Did Bette Davis have thyroid eye disease (TED)? Her prominent eyes are characteristic of a mild case of TED or Graves ophthalmopathy. This eye condition is associated with hyperthyroidism which is also known as Graves Disease where the body directs antibodies against its own thyroid tissue causing the gland to overproduce thyroid hormone. At times, these same antibodies cross-react with the tissues behind the eyeball causing the eye to bulge outwards.
Three times in as many months I have had female patients (this condition--as are all autoimmune problems--is more common in women) look at me through Bette Davis eyes. Not only were their eyes quite prominent, they also displayed lid lag (the eyelids lag behind the eyes' movement as the patient looks downward) and a staring gaze as the retracted upper lids revealed a band of the white part of the eye above the colored iris they looked straight ahead.
One of these patients was indeed hyperthyroid on lab testing while the other two had normal thyroid function. All three women had elevations of the auto-antibody called thyroid stimulating immunoglobulin or TSI. Unfortunately, treatment for hyperthyroidism does not affect the course of the eye problem, and a few patients will ultimately need surgery to not only avoid 'Marty Feldman eyes,' but to relieve the eye irritation that results from an inability to completely close the lids over the eyes.