Graves’ Eye Disease

What is Graves’ eye disease?

Graves’ eye disease occurs when inflammation around the eyes causes them to protrude. This condition is a result of Graves’ disease and is also referred to as GED, Graves’ ophthalmopathy, or thyroid eye disease (TED).

Typically, Graves’ eye disease is mild and may resolve on its own. While it rarely leads to vision impairment, it can result in double vision and other related symptoms. Various treatments are available to alleviate these symptoms.

What is Graves’ disease?

Graves’ disease is classified as an autoimmune disorder. It arises when the immune system mistakenly attacks the thyroid gland, a small gland located at the front of the neck. This attack results in hyperthyroidism, a condition where the body produces excessive thyroid hormone.

Graves’ disease can lead to numerous serious health complications, including eye-related issues.

What are the symptoms of Graves’ eye disease?

The primary symptom of Graves’ eye disease is the protrusion of the eyes, often referred to as proptosis. Additional symptoms may include:

  • Dry, gritty, red, or irritated eyes

  • Swollen eyelids

  • Eyelids that retract more than normal or fail to close completely

  • Double vision

  • Increased sensitivity to light

  • Pain or pressure in the eyes

  • Difficulty moving the eyes when looking around

Graves’ eye disease typically affects both eyes, although symptoms may be more noticeable in just one eye.

Symptoms generally persist for 1 to 2 years and often resolve without intervention. In rare instances, swelling around the eyes can exert pressure on the optic nerve, which connects the eye to the brain, potentially leading to vision loss.

The primary symptom of Graves’ eye disease is the protrusion of the eyes.

Am I at risk for Graves’ eye disease?

Individuals diagnosed with Graves’ disease are at an increased risk for developing Graves’ eye disease. Approximately 1 in 3 individuals with Graves’ disease will experience some form of eye complications.

Smoking heightens the risk of eye issues in those with Graves’ disease. If you smoke, it is advisable to create a plan to quit.

Graves’ disease is significantly more prevalent in women and typically manifests before the age of 40. Your risk is elevated if there is a family history of Graves’ disease or if you have another autoimmune condition, such as rheumatoid arthritis.

What causes Graves’ eye disease?

In some cases, Graves’ disease prompts the immune system to attack the muscles and other tissues surrounding the eyes. This results in swelling behind the eye sockets, causing the eyes to protrude.

Researchers are still uncertain about the exact causes of Graves’ disease. It is believed that individuals with specific genetic predispositions may be more susceptible. Environmental factors, such as viruses, may act as triggers that lead to the development of the disease in genetically predisposed individuals.

Graves’ disease is not contagious; it cannot be transmitted from one person to another.

How will my doctor check for Graves’ eye disease?

Your doctor can diagnose Graves’ eye disease through a comprehensive physical eye examination. During this assessment, your doctor will closely examine your eyes and eyelids.

If your eye doctor suspects the presence of Graves’ disease, you will likely undergo blood tests to evaluate the functioning of your thyroid.

What’s the treatment for Graves’ eye disease?

If you are diagnosed with Graves’ disease, you will require treatment for your thyroid-related issues. Occasionally, thyroid treatments may alleviate some symptoms of Graves’ eye disease, but many individuals will need distinct treatments specifically for their eye conditions.

  • Over-the-counter eye drops. The most common remedy for dry or irritated eyes is a type of eye drop known as artificial tears, which can be purchased without a prescription. There are also over-the-counter gels and ointments that may provide relief for your eyes.

  • Prescription medications. If you experience significant swelling behind your eyes, your doctor may prescribe steroids (such as prednisone) or other medications (like rituximab) to help reduce the swelling. Additionally, your doctor may recommend a newer medication specifically for Graves’ eye disease called Tepezza (teprotumumab).

  • Quitting smoking. Smoking exacerbates Graves’ eye disease, making cessation the most crucial lifestyle change you can undertake if you have this condition. If you smoke, it is essential to devise a plan to quit.

  • Other lifestyle modifications. You can take measures to alleviate some common symptoms associated with Graves’ eye disease.

    • If your eyes are sensitive to light, consider using over-the-counter eye drops and wearing sunglasses when outdoors.

    • If you have swollen eyelids, try elevating the head of your bed so that your head is positioned higher than your body while you sleep.

    • If your eyelids do not close completely, consider taping them shut at night to prevent dryness.

  • Glasses. If you experience double vision, special prescription lenses (known as prism prescriptions) can help correct double vision and improve clarity of vision.

  • Surgery. If Graves’ eye disease impacts your vision, your doctor may suggest a procedure called orbital decompression. This surgery enlarges the eye socket to relieve pressure on the optic nerve and assist in repositioning the eye. If your eyelids are excessively retracted, eyelid surgery may also be recommended to restore them to a more normal position.

  • Radiation. In certain cases, doctors may utilize radiation therapy to treat Graves’ eye disease. This treatment aims to reduce swelling in the muscles and tissues surrounding the eyes.