Graves’ eye disease, also called Graves’ Ophthalmopathy or Thyroid Eye disease, is a problem that usually develops in people with an overactive thyroid caused by Graves’ disease. Graves’ disease is an autoimmune disease caused by antibodies directed against receptors present in the thyroid cells and also on the surface of the cells behind the eyes. This usually results in a generalized overactivity of the thyroid gland (hyperthyroidism). Up to one-half of people with Graves’ disease develop eye symptoms. These are usually mild and treatable.
The eyes are particularly vulnerable to Graves’ eye disease because the autoimmune attack often targets the eye muscles and connective tissue within the eye socket. This likely occurs because these tissues contain proteins that appear similar to the immune system as those of the thyroid gland. Ocular symptoms can range from mild to severe, but only 10-20% of patients have a sight-threatening disease.
Signs And Symptoms Of Graves’ Eye Disease
In Graves’ eye disease, the tissue around the eye is attacked, and the result is inflammation and swelling, causing:
- Redness and pain
- Puffiness around the eyes
- Bulging of the eyes
- Dry eyes and irritation, occurring when the eyelids cannot close completely over bulging eyes
Progressive swelling may cause:
- Increased pressure inside the eye socket
- Pressure-pain or a deep headache, which worsens with eye movements
- Decreased vision, when swollen tissues push on the optic nerve
The muscles around the eye are particularly susceptible to the attack of lymphocytes.
Tests and Diagnosis
If your doctor suspects you have an overactive thyroid gland, your thyroid function must first be evaluated and treated appropriately by an internist trained in doing so. Treatments include medications to suppress the production of hormones by the thyroid gland, radioactive iodine to eliminate hormone-producing cells, and surgery to remove the thyroid tissue. In most cases, replacement thyroid hormone is required following the natural course of the Graves’ autoimmune attack on the thyroid gland or following effective treatment.
Once your thyroid function is treated and returned to normal, the eye disease must be monitored as it often continues to progress. Eye involvement must be evaluated on a continuing basis by an ophthalmologist during the active phase of the disease and, if necessary, treated. Although symptoms often resolve on their own, activity, scarring, and visual loss not readily apparent to the patient may otherwise go unnoticed and cause permanent changes.