Among the potential symptoms of Graves’ disease are irregular heartbeat, weight loss, and an enlarged thyroid gland (goiter).
Sometimes, the immune system attacks tissues and muscles around the eyes. This is a condition called thyroid eye disease or Graves’ ophthalmopathy (GO). Inflammation causes the eyes to feel gritty, dry, and irritated.
This condition can also make your eyes appear to bulge out.
Graves’ eye disease affects between 25 and 50 percent of people who have Graves’ disease. It can also occur in people who don’t have Graves’ disease.
Continue reading to learn more about Graves’ eye disease, medical treatment, and what you can do to relieve symptoms.
Most of the time, Graves’ eye disease affects both eyes. About 15 percent of the time, only one eye is involved. There’s no connection between your eye symptoms and the severity of your hyperthyroidism.
Symptoms of GO may include:
- dry eyes, grittiness, irritation
- eye pressure and pain
- redness and inflammation
- retracting eyelids
- bulging of the eyes, also called proptosis or exophthalmos
- light sensitivity
- double vision
In severe cases, you might have trouble moving or closing your eyes, ulceration of the cornea, and compression of the optic nerve. GO can lead to loss of vision, but this is rare.
Symptoms generally start around the same time as other symptoms of Graves’ disease, but some people develop eye symptoms first. Rarely does GO develop long after treatment for Graves’ disease. It’s also possible to develop GO without having hyperthyroidism.
The exact cause isn’t clear, but it may be a combination of genetic and environmental factors.
The inflammation around the eye is due to an autoimmune response. The symptoms are due to swelling around the eye and retraction of the eyelids.
Graves’ eye disease usually occurs in conjunction with hyperthyroidism, but not always. It can occur when your thyroid isn’t currently overactive.
Risk factors for GO include:
- genetic influences
- iodine therapy for hyperthyroidism
You can develop Graves’ disease at any age, but most people are between the ages of 30 and 60 at diagnosis. Graves’ disease affects about 3 percent of women and 0.5 percent of men.
When you already know you have Graves’ disease, your doctor can make the diagnosis after examining your eyes.
Otherwise, your doctor will likely begin by looking closely at your eyes and checking your neck to see if your thyroid is enlarged.
Then, your blood can be checked for thyroid stimulating hormone (TSH). TSH, a hormone produced in the pituitary gland, stimulates the thyroid to produce hormones. If you have Graves’ disease, your TSH level will be low, but you’ll have high levels of thyroid hormones.
Your blood can also be tested for Graves’ antibodies. This test is not needed to make the diagnosis, but it may be done anyway. If it turns out to be negative, your doctor can start looking for another diagnosis.
Imaging tests such as ultrasound, CT scan, or MRI can provide a detailed look at the thyroid gland.
You can’t produce thyroid hormones without iodine. That’s why your doctor may want to perform a procedure called radioactive iodine uptake. For this test, you’ll take some radioactive iodine and allow your body to absorb it. Later, a special scanning camera can help determine how well your thyroid takes in iodine.
In 20 percent of people with hyperthyroidism, eye symptoms appear before any other symptoms.
Treating Graves’ disease involves certain therapies to keep hormone levels within the normal range. Graves’ eye disease requires its own treatment, since treating Graves’ disease doesn’t always help with eye symptoms.
There’s a period of active inflammation in which symptoms worsen. This can last up to six months or so. Then there’s an inactive phase in which symptoms stabilize or start to improve.
There are quite a few things you can do on your own to ease symptoms, such as:
- Eye drops to lubricate and relieve dry, irritated eyes. Use eye drops that don’t contain redness removers or preservatives. Lubricating gels can also be helpful at bedtime if your eyelids don’t close all the way. Ask your doctor which products are most likely to help without irritating your eyes further.
- Cool compress to temporarily relieve irritation. This may be especially soothing just before you go to bed or when you first get up in the morning.
- Sunglasses to help protect against light sensitivity. Glasses can also protect you from wind or breezes from fans, direct heat, and air conditioning. Wraparound glasses may be more helpful outdoors.
- Prescription glasses with prisms may help correct double vision. They don’t work for everyone, though.
- Sleep with your head raised to reduce swelling and relieve pressure on the eyes.
- Corticosteroids such as hydrocortisone or prednisone can help reduce swelling. Ask your doctor if you should be using corticosteroids.
- Don’t smoke, as smoking can make matters worse. If you smoke, ask your doctor about smoking cessation programs. You should also try to avoid second-hand smoke, dust, and other things that can irritate your eyes.
Be sure to tell your doctor if nothing is working and you continue to have double vision, decreased vision, or other problems. There are some surgical interventions that can help, including:
- Orbital decompression surgery to enlarge the eye socket so the eye can sit in a better position. This involves removing a bone between the eye socket and sinuses to create space for swollen tissue.
- Eyelid surgery to return the eyelids to a more natural position.
- Eye muscle surgery to correct double vision. This involves cutting muscle affected by scar tissue and reattaching it further back.
These procedures can help improve vision or the appearance of your eyes.
Rarely, radiation therapy, or orbital radiotherapy, is used to reduce swelling on the muscles and tissues around the eyes. This is done over the course of several days.
If your eye symptoms are unrelated to Graves’ disease, other treatments may be more appropriate.
There’s no way to completely prevent Graves’ disease or Graves’ eye disease. But if you have Graves’ disease and smoke, you’re five times more likely to develop eye disease than non-smokers. Eye disease tends to be more severe for smokers.
If you receive a diagnosis of Graves’ disease, ask your doctor to screen you for eye problems. GO is severe enough to threaten vision about 3 to 5 percent of the time.
Eye symptoms usually stabilize after about six months. They may start to improve right away or remain stable for a year or two before they start to improve.
Graves’ eye disease can be successfully treated, and symptoms often improve even without treatment.