Thyroid eye disease (also called Grave’s orbitopathy or Grave’s ophthalmopathy) is an autoimmune condition where the immune cells attack the tissues around the eyes. It causes inflammation of the eye muscles or fat. When the immune system attacks the thyroid gland, it results in excessive thyroid hormone secretion or hyperthyroidism (Grave’s disease). Grave’s disease can also result in low thyroid activity (hypothyroidism).
The eyes are particularly vulnerable to thyroid eye disease because the immune system often targets the eye muscles and connective tissue within the eye socket, which have the same protein as that of the thyroid gland. The inflammation targets various parts of the eyes, including:
- The muscle and fat behind the eyes, resulting in protruding eyes
- The muscles that move the eyes result in muscle stiffness; muscle stiffness can cause double vision and sometimes squinting
Most individuals with thyroid eye disease have abnormal thyroid hormone levels. However, there may be individuals who experience eye symptoms even when their thyroid levels are normal or low.
Some of the risk factors associated with thyroid eye disease include:
- Middle-aged individuals
- Family history of thyroid eye disease
- Low blood levels of selenium
- Exposure to radioactive iodine therapy
- Female sex (women are more likely to get thyroid eye disease)
- Cigarette smoking
- People with the overactive or underactive thyroid gland
What is thyroid eye disease?
Thyroid eye disease is an autoimmune disorder affecting the eyes, which is generally associated with Graves’ disease. Grave’s disease is an autoimmune thyroid disease where the immune cells attack the thyroid gland, resulting in excessive thyroid hormone secretion. When the immune system attacks the eyes, it results in thyroid eye disease.
What are the symptoms of thyroid eye disease?
Some of the most common symptoms of thyroid eye disease include:
- Change in the appearance of the eyes (usually staring or bulging eyes)
- A feeling of grittiness or excessive dryness in the eyes
- Watery eyes
- Intolerance to bright lights
- Swelling or feeling of fullness in the upper or lower eyelids
- New bags under the eyes
- Redness of the eyelids and eyes
- Blurred or double vision
- Pain in or behind the eyes, especially when looking up, down, or sideways
- Difficulty moving the eyes
Progressive swelling may cause
- Extreme pressure inside the eye socket.
- Pressure pain or deep headache, which exacerbates with eye movements.
- Decline in vision when swollen tissues press the optic nerves.
As the symptoms worsen, many patients fear they will lose their vision. However, patients usually do not go blind from Graves’ eye disease.
How is thyroid eye disease treated?
The main goal of the treatment is to stabilize the thyroid function and reduce inflammation of the eyes.
Some of the treatment options that the physician may recommend to soothe the eyes include:
- Applying a cool compress to the eyes
- Wearing sunglasses to protect the eyes from the sun and wind
- Using artificial teardrops or lubricating eye drops to relieve dryness and scratchiness
- Elevating the head while lying down
- Quitting smoking
- Taking steroid supplements to ease swelling
- Taking selenium supplements
- Wearing glasses having prisms to treat double vision
- Surgery of the eyelids and eye muscles or eye socket surgery
- Infusing medications into the veins of the eyes
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