When to check the thyroid in a patient presenting with dry eye:
(1) conjunctival hyperemia
(2) subtle widening of the interpalpebral fissure
(3) chemosis overlying the extraocular muscles (particularly the rectus muscles)
(4) presence of an autoimmune disease (Sjogren's disease, rheumatoid arthritis, etc)
(5) tachycardia, weight loss, sweating or other symptoms that can be seen with hyperthyroidism
(6) history of thyroid disease
Most patients will show tear film abnormalities and the cornea may show fluorescein staining.
If the dry eye is a manifestation of thyroid eye disease, then treatment of the hyperthyroidism should improve the dry eye manifestations.
