Graves’ eye disease: symptoms, causes and treatment

Reviewed by Dr. Michael Kessler, DC — Graves’ eye disease, also known as Graves’ ophthalmopathy or thyroid eye disease, is a rare condition that can affect people with hyperthyroidism.

Hyperthyroidism is most often caused by a condition known as Graves’ disease. However, Graves’ disease and Graves’ eye disease are not necessarily related the way you might think.

Instead, the two conditions engage in a somewhat strange cycle.

What is Graves’ disease?

Graves’ disease (which does not specifically affect the eyes) is an autoimmune disorder that causes an overactive thyroid gland (hyperthyroidism). The disease causes the immune system to attack healthy thyroid tissue and increase the production of thyroid hormone.

The eyes are particularly susceptible to Graves’ disease because they contain muscle and connective tissue that looks very similar to those of the thyroid gland, causing antibodies to attack both sites.

However, treating hyperthyroidism associated with Graves’ disease will not cure Graves’ ocular disease. Each case goes its own way.

Thyroid function and hyperthyroidism

Before we examine the symptoms and possible causes of Graves’ eye disease, it’s important to learn the basics of thyroid function.

The thyroid is a butterfly-shaped endocrine gland located in the lower part of the front of the neck. Its function is to produce hormones that are secreted into the blood to perform a variety of metabolic purposes. Helps the body:

• Use energy
• Energy storage
• Maintaining the proper functioning of major organs (brain, heart, muscles).
• Regulating internal temperature
• Managing cell metabolism and growth

Thyroid disease comes in two forms: hypothyroidism and hyperthyroidism.

Hypothyroidism It is when the thyroid gland is underactive and does not produce enough thyroid hormone. It is characterized by symptoms such as:

• exhaustion
• Slow heartbeat
• Weight gain
• Sensitivity to cold
• Pains
• holding
• Brain fog
• depression
• Slow motion
• Muscle cramps

Hyperthyroidism She is hyperthyroid, which means she produces too much thyroid hormone. Many of its symptoms are the opposite of hypothyroidism. It is characterized by the following:

• Rapid heartbeat
• Throbbing
• Sweating
• Irritability
• High blood pressure
• Unexplained weight loss
• Heat intolerance/heat sensitivity
• Hair loss/changes in hair quality

Graves’ disease can cause hyperthyroidism, but hyperthyroidism does not cause Graves’ ocular disease.

Symptoms of Graves’ eye disease

Common symptoms of Graves’ eye disease include:

• Redness and pain in and around the eye
• Bloating
• Puffy eyes / drooping eyelids
• Dry and irritated eyes (generally occurs when the eyelids cannot close completely over puffy eyes)

Progressive swelling may lead to:

• Increased pressure in the eye socket
• Pressure pain/deep headache that worsens with eye movements.
• Decreased vision (caused by swelling of tissue pressing on the optic nerve)
• The eyes are pushed forward into the sockets – a bulging or “squinting” appearance.
• Restriction of normal eye movement, leading to double vision.

Although fear is common, blindness is very rare among patients with Graves’ eye disease.

Causes of Graves’ disease and risk factors

The symptoms of Graves’ eye disease are a direct result of immune attacks on the tissues in the eye socket. Swelling and scarring lead to the above symptoms.

However, the cause of Graves’ disease is currently unknown.

Nearly 1 million people in the United States have Graves’ eye disease.

Gender and smoking status appear to play major roles in risk. Women are five to six times more likely to develop Graves’ disease men.

Smokers also have a much higher risk. They are also significantly more likely to develop severe symptoms than non-smokers.

Although Graves’ disease and Graves’ eye disease are rooted in the immune system attacking healthy tissue, one disease does not necessarily cause the other. They may not even occur at the same time.

Treatments for Graves’ eye disease

Symptoms can range from mild to severe. However, most people with Graves’ disease will likely experience some degree of eye puffiness or eyelid retraction.

Most people with mild to moderate cases will notice periods of spontaneous improvement over a few years, or may just adapt to it.

Approximately 10% to 20% of patients develop severe symptoms, and 10% may experience threats to vision.

Treatments depend on the severity of the patient’s condition and the doctor’s approach.

Current treatments include:

• Steroids: Steroids such as hydrocortisone and prednisone are used to treat swelling and control inflammation.
• Eyelid surgery: Doctors may recommend eyelid surgery if a patient has increasing difficulty closing their eyelids.
• Eye muscle surgery: Scar tissue can sometimes cause one or more eye muscles to shorten and pull the eye out of alignment. The goal of surgery is to realign the eye to improve double vision by cutting the muscle tissue and reattaching it back into the eye socket.
• Radiotherapy: This is often used in conjunction with steroid therapy to help target antibodies and calm inflammation in people with moderate to severe thyroid eye disease.

Manage Graves’ eye disease naturally

There are less invasive ways to reduce the discomfort of Graves’ eye disease. If your condition is mild to moderate, you may benefit from the following:

• Sunglasses: Graves’ disease can make your eyes more vulnerable and sensitive to the elements. Sunglasses can help mitigate the effects of harmful UV rays, light and wind on protruding eyes.
• Cold compresses: The moisture from cold compresses may provide relief from pain and swelling.
• Lubricating eye drops: Eye drops with lubricants may help relieve symptoms such as itching around the eye. They can also help reduce eyelid scratching, and may be especially helpful at bedtime. Do not use options that contain redness removers.
• Head lift: When lying in bed, try using an extra pillow to support your head higher than the rest of your body. This may help prevent swelling and increased pressure in your eyes and head.
• prism: If you have double vision, your doctor may prescribe prism lenses.

Graves’ eye disease: rare but treatable

Graves’ eye disease is a rare condition that, although uncomfortable and worrying, is treatable and unlikely to lead to vision loss. Unfortunately, treatment for hyperthyroidism will not travel to the eyes. If you’re concerned that you may have Graves’ eye disease, talk to your doctor.