What is Graves’ disease?
Graves’ disease is a disorder in which your immune system damages your thyroid, causing hyperthyroidism. The thyroid is a small gland in your neck that produces hormones that keep your other organs — including your heart, brain, and lungs — working as they should.
In hyperthyroidism, your thyroid is overactive, flooding your body with high levels of thyroid hormones. This leads to symptoms such as:
- Tachycardia (rapid heart rate)
- Tremors in the hands
- Insomnia (difficulty falling asleep or staying asleep)
- Weight loss
- Muscle weakness
Up to half of the people who have Graves’ disease develop eye symptoms and are diagnosed with thyroid eye disease (TED). Thyroid eye disease is also known as Graves’ eye disease or Graves’ ophthalmopathy.
Most cases of thyroid eye disease are mild and easily treatable.
Signs of Thyroid Eye Disease
Eye symptoms typically appear about six months before or after a Graves’ disease diagnosis and can include:
The whites of the eyes or the eyelids may appear red and inflamed. This is often one of the earliest symptoms of graves’ eye disease.
Another early symptom is proptosis, which means your eyes bulge outward. Your eyelids may also retract, leading to dryness and discomfort.
Eye irritation or pain
Your eyes may feel gritty and dry or be excessively teary. They may hurt or be extremely sensitive to bright light (photophobia). You may also have an uncomfortable feeling of pressure in your eyes.
Double vision (diplopia) can be an early symptom of Graves’ ophthalmopathy. If the disease progresses, later symptoms can include trouble moving your eyes, being unable to completely close your eyes, and vision loss.
Causes of thyroid eye disease
In thyroid eye disease, your body’s immune system causes inflammation in the tissues around your eye, which causes redness, swelling, and the other symptoms described above.
The immune system’s attack on your eye also triggers the production of extra muscle and fat in your eye socket. This extra tissue is what causes your eyes to bulge out.
Swelling of your eyelids can make them puffy and red. If the swelling causes your eyelids to retract, your eye is more exposed and therefore more vulnerable to dryness and infection.
In some cases, swelling can stiffen the muscles that move your eye so that they cannot work properly. In 5% of people with Graves’ disease, eye swelling is so severe that it puts pressure on the optic nerves that connect your eyes to your brain, causing vision loss.
People with Graves’ disease who smoke cigarettes are much more likely to have eye symptoms. Their symptoms also tend to be more severe than eye symptoms in people with Graves’ disease who do not smoke.
Diagnosis of thyroid eye disease
If you have already been diagnosed with Graves’ disease, your doctor may diagnose thyroid eye disease based on your symptoms and the signs they observe. They may order imaging such as a computed tomography (CT) scan or magnetic resonance imaging (MRI).
Imaging is painless and can show changes in the structures around your eye that can confirm a thyroid eye disease diagnosis.
Treatments for thyroid eye disease
There are numerous options to help relieve the symptoms of thyroid eye disease. These include:
Lubricating eye drops may help with dryness and irritation. Choose eye drops that do not contain redness removers. If your eyelids do not close completely while you sleep, you can apply a lubricating gel just before bed to prevent dryness.
Applying a cool compress to your eyes may relieve some of the dry, gritty feeling and reduce swelling.
Wearing sunglasses helps protect your eyes from wind and decrease the impact of light sensitivity.
Steroids may help with swelling. There is also a new medicine called teprotumumab-trbw available for the treatment of Graves’ disease. It helps with the symptoms of thyroid eye disease and may reduce your need for eye surgeries.
An ophthalmologist (eye specialist) can reposition eye muscles or the eye itself to fix eyelid retraction or improve your vision. They can also remove scar tissue from your eye muscles to restore movement of your eye.
A surgery called orbital decompression can relieve pressure on your optic nerve to preserve vision.
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