Graves' Eye Disease (Graves' Ophthalmopathy)
What Is It?
Graves' eye disease, also called Graves' ophthalmopathy, is a problem that develops in people with an overactive thyroid caused by Graves' disease. Up to one-half of people with Graves' disease develop eye symptoms. Usually the eye symptoms are mild and easily treated.
Eye problems result from the swelling of tissues, muscles and fat in the socket behind the eye. This swelling causes exophthalmos, an abnormal protrusion of the eye, commonly associated with Graves' disease. In serious cases, the swelling can cause the muscles that move the eyeball to become so stiff that the eye cannot move properly, or the swelling can put pressure on the optic nerve, impairing vision. The eyelids and membranes may retract as they swell, which can lead to exposure and infection of the cornea, the transparent, dome-shaped "window" that lies directly over the eye's pupil and iris.
Symptoms of Graves' eye disease include:
- Early symptoms - Feeling of irritation in the eyes, double vision, excessive tearing or dry eye, forward displacement of the eye, and sensitivity to light
- Late symptoms - Swelling of the eye, inability to move the eye, corneal ulceration, and, rarely, loss of vision
If you already have been diagnosed with Graves' disease, a doctor may diagnose eye disease by examining your eyes and finding swelling and enlargement of the eye muscles. A computed tomography (CT) scan or magnetic resonance imaging (MRI) scan of the eye muscles may be helpful. Graves' disease usually is associated with other symptoms of overactive thyroid. However, the classic symptoms of hyperthyroidism are not always present. In fact, Graves' eye disease can occur even when the thyroid is not overactive at that time.
Graves' eye disease usually improves on its own, but in some cases, it must be treated.
Graves' disease cannot be prevented, and usually, the associated eye disease cannot be prevented. However, some studies suggest that patients with hyperthyroidism from Graves' disease who are given corticosteroids, such as prednisone (sold under several brand names), by mouth at the same time they receive radioactive iodine therapy have less risk of developing Graves' eye disease. Smokers are more prone to develop Graves' than nonsmokers.
In mild cases, cool compresses, sunglasses and artificial tears provide relief. People with Graves' eye disease often are advised to sleep with their heads elevated to reduce eyelid swelling. If double vision is a continuing problem, glasses containing prisms may be prescribed or surgery on the muscles may be advised.
Corticosteroids, taken by mouth, may help temporarily with early stages of eye-muscle problems, but they are not effective later in the disease. Corticosteroids, taken by mouth or given intravenously (into a vein), may be used to treat compression of the optic nerve, which is the most serious complication of Graves' eye disease.
In more stubborn cases, external radiation treatment of the eye socket may be considered to ease swelling. However, studies on the long-term benefits of external radiation are not conclusive. Also radiation near the eye may damage the retina.
The most common surgery for Graves' eye disease is eyelid surgery to reposition the eyelid. In addition, surgery on the eye muscles can be done to realign the eyes. These procedures are performed by an eye specialist called an ophthalmologist.
When sight is threatened, a type of surgery called orbital decompression is done. In this procedure, a bone between the eye socket (orbit) and sinuses is removed to allow more space for the swollen tissues. This more complicated operation requires a medical center with expertise in this area.
It is important that thyroid blood levels be maintained in the normal range. After treatment of an overactive thyroid, there is a substantial risk of becoming hypothyroid (an under active gland). Thyroid replacement is essential to help keep Graves' eye disease from getting worse.
When to Call a Professional
Call your doctor if you notice any changes in the appearance of your eye or if you develop any of the symptoms of Graves' eye disease.
Most of the symptoms of Graves' disease, including eye symptoms, can be treated successfully.
American Thyroid Association, Inc.
6066 Leesburg Pike
Falls Church, VA 22041
Thyroid Foundation of America, Inc.
410 Stuart St.
Boston, MA 02116