As I've mentioned before, some Graves Disease patients develop an associated problem called Thyroid Eye Disease (actually, I think the technical name is Graves ophthalmopathy). I am one of those patients. Basically it works like this: My immune system makes antibodies that, for reasons unknown to doctors, attack certain tissues in my body. Those tissues include the thyroid, as well as around the eyes and the lower leg/foot (called Graves dermopathy). Specifically, the antibodies target fibroblasts, which can differentiate into fatty, collagen-like cells. These expand, and the muscles become inflamed. The eye's natural ability to drain fluids becomes challenged, and swelling occurs.
This is why if you ever look closely at my face, you'll notice swelling of the area around my eyes. The swelling causes my eyes to bulge or protrude from my face, such that the upper eyelids retract, and I sometimes look like I'm surprised. Since more of my eyes are exposed, they dry out more quickly and appear red. It also explains why I'm constantly wiping my eyes, as well as putting in drops. My body tries to produce more tears to keep the eyes moist, but that's often not enough. Also because of the bulging, I'm much more sensitive to bright lights, wind, heat, and cold.
You may be thinking at this point, "That's unfortunate, but what does this have to do with your sleeping?" Put simply, because the swelling is pushing my eyeball further out of the socket, my eyelids--which are only so long--can't fully close at night. If I try really hard, I can close the lids on my left eye. But who can maintain that when they sleep? Not me, and I end up with an eye that closes about 90-95%.
Perhaps that doesn't sound like a big problem, but even the smallest bit makes a difference. Without fully closed eyelids to keep in the moisture, my left eye (which protrudes more than my right) has a tendency to get really dry. In fact, I wake up at least three times every night because the pain of a dry eye is so sharp. I have eye drops on my nightstand, but that's only a temporary relief. Sometimes, if my body is so tired that it tries to ignore the pain, I'll wake up with big tears streaming down my face because my body's doing everything it can to prevent my eye from drying out. It's been at least 18 months since I've slept through the night without waking up because of this. And as I implied above, this is just as much an issue during the day when I'm awake.
The good news is the problem is less painful when I'm less stressed. Since leaving work in June 2011, I've had no more than three or four nights when the pain was so intense I started crying on top of the crying my eyes needed to stay lubricated. Before that, I had three or four of those nights...per week. In addition to that, I've started drinking more water and taking selenium supplements, as suggested by the ophthalmologist at the Mayo Clinic. Both are helping.
The bad news is that the "damage" that's done is likely permanent. The swelling may go down slightly over time, but all my doctors have said that what's done is done. There is a surgical option to reduce the swelling. That's actually a fiction, though, because doctors don't actually remove the swollen, fatty tissue. Instead, they shave away some of the bone in my skull to create essentially a bigger eye socket. That gives my eye and its associated inflammation more room to settle in, thus reducing some of the proptosis (bulging). While this may be inevitable for me, I'm not crazy about the idea as of today. I've never had surgery, I don't know if insurance covers it, recovery would last a week followed by temporary double vision, and I keep wondering what happens if there's a complication.
So there's a look into my eyes. I guess you could call them a window to my Graves Disease. Gives new meaning to the idea of sleeping with one eye open, huh? I actually do!
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