Graves’ disease is an autoimmune disorder that causes your thyroid gland to produce more hormones than it should. Overactive thyroid is called hyperthyroidism.
Some potential symptoms of Graves’ disease are irregular heart rate, 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 bulge out. This bulging is usually worse in one eye compared with the other.
Graves’ eye disease affects around
Symptoms of GO may include:
- eye dryness
- eye grittiness
- eye irritation
- eye pressure and pain
- eye redness and inflammation
- retracting eyelids
- bulging of the eyes, also called proptosis or exophthalmos
- light sensitivity
- double vision, also called diplopia
In severe cases, you might also have:
- trouble moving or closing your eyes
- exposure and ulceration of the cornea
- compression of the optic nerve
GO can lead to loss of vision, but this is rare.
Most of the time, Graves’ eye disease affects both eyes. Up to 14 percent of the time, only one eye is involved.
There’s no connection between your eye symptoms and the severity of hyperthyroidism.
Symptoms generally start around the same time as other symptoms of Graves’ disease, but eye problems develop first in about 20 percent of people with the disease. Rarely does GO develop long after treatment for Graves’ disease.
For people with GO, there’s a period of active inflammation around the eyes during which symptoms worsen. This can last up to 6 months. Then there’s an inactive phase in which symptoms stabilize or start to improve.
The exact cause of GO 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. With GO, the same abnormal immune response that triggers the thyroid gland in Graves’ disease affects the muscles and soft tissues around the eye. This leads your body to produce an inflammatory response.
Symptoms develop because of swelling around the eye, forward bulging of the eyes, and retraction of the eyelids.
Graves’ eye disease usually occurs in conjunction with hyperthyroidism, but not always. It can occur even when your thyroid isn’t currently overactive.
Risk factors for GO include:
- genetic influences
- smoking
- iodine therapy for hyperthyroidism
Women are also at a higher risk of developing GO compared with men.
There’s no way to completely prevent Graves’ disease or Graves’ eye disease. But if you have Graves’ disease and you smoke, you’re around 5 times more likely to develop eye disease than people who don’t smoke. Plus, eye disease tends to be more severe for those who smoke.
When you already know you have Graves’ disease, a doctor can make a diagnosis of GO after examining your eyes. A specialized doctor called an ophthalmologist will help you manage GO, while your primary care doctor or endocrinologist will manage hormone treatment for Graves’ disease.
If you don’t already have a diagnosis of Graves’ disease, your doctor will likely begin by looking closely at your eyes and checking your neck to see whether 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 isn’t 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 might also be done so the doctor can get a detailed look at the thyroid gland.
Your doctor may also 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, which helps inform the diagnosis of Graves’ disease.
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 one approved medication for active thyroid eye disease called teprotumumab (Tepezza). It was shown in
There are quite a few things you can try on your own to ease symptoms of GO, including:
- Eye drops. 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 ophthalmologist which products are most likely to help to relieve dry, irritated eyes.
- Cool compress. For temporarily relief of irritation, try gently pressing a cool compress on or around your eyes. This may be especially soothing just before you go to bed or when you first get up in the morning.
- Sunglasses. Sunglasses may help with light sensitivity and can also protect your eyes from wind or breezes from fans, direct heat, and air conditioning. Wraparound glasses may be more helpful outdoors.
- Prescription glasses. Glasses with prisms may help correct double vision. They don’t work for everyone, though.
- Extra head support. Try sleeping with your head raised to reduce swelling and relieve pressure on the eyes.
- Corticosteroids. Steroids such as hydrocortisone or prednisone can help reduce swelling around your eyes, but they can also cause side effects. Ask your ophthalmologist if you should be using corticosteroids.
- Avoiding smoke. Smoking can make your eye symptoms worse. If you smoke, talk with your doctor about smoking cessation programs. You should also try to avoid secondhand smoke, dust, and other things that can irritate your eyes.
Be sure to tell your ophthalmologist if nothing is working and you continue to have double vision, decreased vision, or other problems.
There are some surgical interventions that can help, too. These include:
- Orbital decompression surgery. This procedure is used to enlarge the eye socket so the eye can rest in a better position. This involves removing sections of paper-thin bone between the eye socket and sinuses to create space for swollen tissue.
- Eyelid surgery. This surgery returns the eyelids to a more natural position.
- Eye muscle surgery. This surgery is done to correct double vision. It involves cutting muscle affected by scar tissue and reattaching it further back in your eye.
These procedures can help improve vision or the appearance of your eyes.
Rarely, radiation therapy, called 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.
GO is a medical condition with ups and downs. Treatment options will change depending on the severity of your symptoms. In general, GO can be successfully treated with medication, home remedies, or surgery.
Because the disease is so dynamic, your doctor won’t rush to offer surgery unless there’s a vision emergency.
Symptoms can improve even without treatment, but treatment can help lower the chance of permanent damage to the eyes from inflammation. With proper treatment, most people with GO improve over time. Symptoms will usually stabilize after about 6 months. They may start to improve right away or remain stable for a year or two before they start to improve.
While the symptoms can be frustrating and disruptive to your everyday life, it’s very rare for GO to cause blindness, especially with the right treatment.
If you receive a diagnosis of Graves’ disease, consider finding an ophthalmologist to screen you for eye problems and let your doctor know right away if you have any bothersome eye symptoms.