Graves’ Ophthalmopathy

What is Graves’ Ophthalmopathy?

Graves’ ophthalmopathy is an autoimmune disease. It occurs when the immune system attacks the tissues around the eyes.

Other names for this condition include:

• Graves’ eye disease
• Thyroid eye disease
• Graves’ orbitopathy
• Thyroid-associated ophthalmopathy

Around one in three people develop Graves’ eye disease from Graves’ Ophthalmopathy. It causes the thyroid gland to produce too much thyroid hormone (hyperthyroidism), affecting the rate of metabolism in the body.

Severe forms of Graves’ eye disease can lead to vision loss. See your doctor right away if you experience symptoms of Graves’ eye disease.

What Are the Symptoms of Graves’ Ophthalmopathy?

Eye symptoms associated with Graves’ disease are generally mild and easy to treat. Graves’ eye disease typically affects both eyes, but symptoms may only be apparent in one eye.

Common symptoms of Grave’s eye disease include:

• Dry, itchy, irritated eyes
• Bug-eyed look due to bulging eyes
• Light sensitivity (photophobia)
• Teary eyes
• Eyelid swelling
• Eye pain or pressure around the eyes
• Trouble closing the eyes completely
• Double vision (diplopia)
• Pain when you move your eyes either up and down or left to right

Rarely, swelling around the eyes can pressure the optic nerve and cause vision loss.

What Causes Graves’ Eye Disease?

Many people with Graves’ disease develop Graves’ eye disease. This is due to the negative response of the immune system from an overproduction of thyroid hormones.

Graves’ disease causes the immune system to attack the muscles around your eyes (extraocular muscles). This leads to swelling behind your eye sockets. The swelling causes eye symptoms like bulging eyes and difficulty closing the eyelids.

Because thyroid hormones play a vital role in various body systems, the disease severity of Graves’ ophthalmopathy can differ significantly.

Hashimoto’s thyroiditis is another type of thyroid dysfunction that may cause Graves’ eye disease. 

How Is Graves’ Eye Disease Diagnosed? 

If you believe you have Graves’ eye disease, you should seek medical attention. Your eye doctor will check for Graves’ ophthalmopathy with a comprehensive eye exam. They’ll carefully examine your eyes and eyelids.

Your eye doctor may recommend additional testing to diagnose Graves’ disease as an underlying cause of other symptoms. Your doctor will review your medical and family history and perform a physical exam. 

They may order one or more thyroid tests to confirm a diagnosis of Graves’ disease. These include:

• Blood tests
• Radioactive iodine uptake test
• Thyroid scan
• Doppler blood flow measurement

What Does Graves’ Eye Disease Look Like?

Graves’ eye disease causes swelling in the muscles and other tissues behind the eyes. This may make the eyes bulge and stick out beyond their normal position. 

Other clinical features of Graves’ eye disease include:

• Upper eyelid retraction
• Swelling of tissues in and around the eye socket
• Eye redness
• Swollen eyelids
• Proptosis (bulging eyes)

Hashimoto’s Thyroiditis vs Graves’ Disease

Hashimoto’s thyroiditis has some overlaps in symptoms with Graves’ disease, but their treatments differ. Hashimoto’s thyroiditis comes from hypothyroidism, while Graves’ disease comes from abnormal thyroid response leading to hyperthyroidism.

When left untreated, hypothyroidism from Hashimoto's disease can lead to health problems, including high cholesterol, heart disease, and heart failure.

Thyroid disorders like Grave’s disease and Hashimoto’s thyroiditis are not contagious, so you can’t catch these conditions from people who have them. However, they both have genetic links, so you’re more likely to inherit these conditions if someone in your family has one of them.

Who is at Risk of Developing Graves’ Ophthalmopathy?

People who have Graves’ disease face a high risk of developing Grave’s eye disease.

Graves’ disease is the underlying health problem in nearly all cases of Graves’ ophthalmopathy. Women and people over age 40 are more likely to develop Graves’ disease.

Other risk factors for Graves’ eye disease include:

• Smoking cigarettes
• Hyperthyroidism
• Receiving radioactive iodine treatment
• Having a family history of Grave’s disease
• Having another autoimmune disease, such as rheumatoid arthritis or Crohn’s disease

Not only does smoking increase your risk for Graves’ eye disease, but it also makes the condition more severe. This is because smoking compromises the immune system, increasing your risk for various diseases.

Listen In Q&A Format

Graves’ Ophthalmopathy

Vision Center Podcast

How Is Graves’ Eye Disease Treated?

Treatments for Graves’ eye disease vary depending on the severity of your symptoms. Mild thyroid eye disease is typically not highly progressive and often goes away on its own, usually lasting approximately 1-2 years.

However, it’s essential to speak with your eye doctor because thyroid eye disease is a potentially vision-threatening condition. People with this condition may not always return to their normal orbital anatomy.

Home Remedies

Most cases of Graves’ eye disease are mild and can be managed at home. Home remedies include:

• Over-the-counter eye drops (artificial tears). This common treatment can relieve irritated or dry eyes
• Wearing sunglasses. This addresses light sensitivity and prevents you from exacerbating symptoms
• Sleeping with your head raised. This reduces eyelid puffiness and swelling
• Taping your eyelids shut at night. This helps prevent dry eye
• Quitting smoking. It’s best to avoid smoking since it can weaken the immune system and make it more prone to Graves’ disease symptoms.

Professional Treatments

If your eye symptoms are severe, or if home remedies don’t work, your doctor may recommend one or more of the following:

• Prescription medicines. Oral steroids like prednisone can reduce swelling, or your doctor may prescribe a new medicine called teprotumumab that specifically treats Graves’ eye disease.
• Thyroid hormone medication. If Graves’ disease is the cause of your eye problems, you will need treatment to balance your thyroid hormones. This usually involves taking levothyroxine to manage your hyperthyroidism.
• Special eyeglasses. To fix double vision and help you see more clearly.
• Orbital radiotherapy. A radiation treatment to help reduce swelling around the eyes.
• Orbital decompression surgery. This procedure makes the eye socket larger, which helps relieve pressure on the optic nerve and moves the eye into its correct position.
• Eyelid surgery. This procedure fixes eyelids pulling back too far and allows them to return to their normal position.

Summary

Graves’ eye disease is a group of eye problems commonly associated with Graves’ disease. Graves’ disease is an autoimmune disorder that causes the immune system to attack healthy tissues around the eye.

Although Grave’s eye disease is usually mild, its symptoms may lead to vision loss. It’s essential to see an eye doctor if you see signs of this condition, which include bulging eyes and eyelids that don’t close all the way.

Common treatments include eye drops and oral steroids. Some people may require special glasses to correct double vision. In severe cases, radiotherapy or surgery may be necessary. It’s best to consult your eye doctor to receive the best treatment for your condition.