Graves’ Disease (Graves’ Ophthalmopathy)

Graves' disease is an immune system disorder that results in the overproduction of thyroid hormones causing a number of physical reactions, including weight loss, rapid heart rate, sweating, and changes to bone, skin, and nails. The eyes may be affected through a separate, yet related disease called Graves’ Ophthalmopathy. In Graves’ Ophthalmopathy, the immune system targets the area surrounding eyes and may cause inflammation, redness, achiness, pink eye, eyelid retraction and bulging eyes.

In extreme cases of Graves’ Ophthalmopathy, swollen eye muscles may put extreme pressure on the optic nerve, leading to double vision, or vision loss.

What Causes Graves’ Ophthalmopathy?

Graves' Ophthalmopathy is an autoimmune condition where the body's immune system produces an antibody to cells in the thyroid gland causing an overproduction of thyroid hormones. It appears that the same antibody that can cause thyroid dysfunction may also have an "attraction" to tissues surrounding the eyes causing the onset of Graves' Ophthalmopathy.

Symptoms of Graves’ Ophthalmopathy

An eye care professional can determine the presence of Graves’ Ophthalmopathy through a thyroid function test after observing common symptoms.

The most common symptoms of Graves’ Ophthalmopathy, affecting about 30% of people with Graves' disease, are associated with inflammation, swelling and redness of the eyes. Symptoms vary from patient to patient and can include:

  • Eye inflammation
  • Eye redness
  • Bulging eyes
  • Dryness or gritty sensation in the eyes
  • Pressure or pain in the eye(s)
  • Light sensitivity
  • Double vision or vision loss

Treatment for Graves’ Ophthalmopathy

Symptoms of Graves’ Ophthalmopathy may get worse for a few months during treatment for Graves' disease, but then stabilize without intervention. Treatments for Graves' disease may include:

Overactive thyroid treatments for Graves' disease:

  • Radioiodine therapy: a treatment in which radioiodine is ingested to kill overactive thyroid cells
  • Systemic medications: used to interfere with the thyroid's ability to produce hormones and/or block the effect of the hormones on the body
  • Thyroid surgery: used for the removal of the overactive thyroid gland, accompanied by hormone replacement therapy

Symptom-based treatments for Graves' Ophthalmopathy:

  • Over the counter: artificial tears during the day and lubricating gels for night time
  • Prescription medications: corticosterioids may reduce swelling behind your eyeballs
  • Prisms: if you have double vision, prisms in your glasses may help
  • Surgery: surgical options are available for several symptoms of Graves’ Ophthalmopathy, including procedures to remove portions of the orbital region to make room for swollen tissue, realign weakened eyes to prevent double vision, and relieve discomfort and appearance issues associated with retracted eyelids

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