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.

7 comments:

rlbates said...

I always thought Bette might have had TED. Interesting that you have seen so many in such a short time frame.

Mauigirl said...

Makes sense. I have the opposite problem - droopy eyelids. (Yes, I've run to a neurologist to be checked for myasthenia gravis!). Apparently it's just old age!

Femail doc said...

Had a lady in the other day with one Bette Davis prominent eye, the other normal. Don't know what to make of it; she said it had been that way for years.

Mg: Droopy lids that interfere with your field of vision can sometimes be fixed at the insurance company's expense. An all expense-paid lift lid!

Mauigirl said...

Good to know! I actually went so far as to get the name of the plastic surgeon who does it from my eye doctor...but haven't gotten around to calling for an appointment. The one eyelid is definitely starting to affect my vision a bit so that one would be covered. But I'd like them both lifted, so we'll see if I can pull it off to get them both covered!

Mrs Fieldzee said...

I had orbital decompression in both eyes June 5 2007. Since then I have had two eyelid procedures. I have another one scheduled for September 8th. I only hope this will be the last one and that my eyes will be even again. I have had Graves for over ten years now. The thyroid eye disease started about six years ago. The pain in back of my eyes (especially my right eye) was unbearable. Thank goodness for the chance meeting of a fabulous Doctor I met out in Edmonton Alberta in December of 2006. Every other Doctor/Eye Doctor told me I just had a serious case of eye dryness (which I do as well). The after effects of the original surgery is that I no longer have the same level of pain in my eyes, but I have no feeling in parts of my face due to the nerves being cut. At least Bette Davis' eyes were symetrical. LOL

Annettte said...

I've had GD for about 24 yrs now. I am STILL on PTU.. 50 mgs daily and doing great. Everyone I know who has gotten the RAI has gotten cancer. Every single one.. about 6?
I try to convince 'newbies' to stick with the antithyroid meds... so many have had luck.. look up Elaine Moore.. she has a Hyperactive website for years.. several books as well.

Brenda Jolley said...

I have had to TED for over 20 years. I had eyelid surgery to bring the eyelids down 10 years ago. My eyes feel much better I also take a lot of fish oil for dry eyes. What is RARTe