Graves' Disease Eye Problems

Graves' disease, which is also called thyroid eye disease, occurs when problems with the thyroid gland's hormone production causes changes in the eyes. Usually hyperthyroidism (overproduction of hormones) is the culprit in eye symptoms associated with Graves' disease, but the eyes can be affected even when the hormone levels are normal or below normal.

Causes

• No one knows what causes the eye changes in Graves' disease, but the immune system is involved, causing inflammation in the tissues around the eye. Women are five times more likely to develop thyroid eye disease than men, and the condition usually appears in the patient's 20s or 30s. It can last months or even years.

Symptoms

• The most obvious symptom of Graves' disease is protruding eyes which cause a fixed, staring appearance. Fluid, fat and inflammatory cells build up in the tissues around the eye, causing pressure and swelling which bulge the eyes outward. This sometimes makes it difficult for the patient to close her eyelids, especially during sleep. This eye protrusion, called proptosis, appears in 70 to 90 percent of cases. The inflammation sometimes becomes so great that it exposes the cornea to drying, inflammation, infections and corneal ulcers. The increase in pressure in the eyes can also lead to glaucoma or impair the optic nerve, resulting in severe vision loss or blindness.
  The condition can also cause swollen eyelids, double vision, eye irritation, conjunctivitis and watering eyes. In some cases, scarring of the muscles that move the eyes may occur, causing permanent impairment of eye movements.

Prognosis

• Thyroid eye disease varies widely in severity and length of symptoms. Eye problems associated with Graves' disease are not always relieved when the doctor brings the thyroid disorder under control; in some cases, the eye symptoms last up to another 2 years.

Treatment

• Milder cases of corneal irritation can be treated with tear supplement drops and pressure dressings. The patient may have to take antibiotics frequently to fight infection resulting from ulceration of the cornea. Doctors may prescribe steroids to reduce inflammation and help combat swelling and eye protrusion.

Surgical Options

• More severe cases of proptosis may require an operation to suture part of the eyelids closed to help protect the cornea. In some cases, a doctor may perform surgery to weaken the muscles of the upper eyelids and cause them to droop to better cover the eyes. Surgery can also make more room for the swollen eye tissue and decrease protrusion.
  In cases of double vision, the patient cannot undergo surgery until the disease has stabilized; once the progression has stopped, doctors can reposition the eye muscles and repair the imbalance.