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Thyroid-Related Ophthalmopathy (Graves’ Disease)
Graves’ disease is an “autoimmune” disease (one in which the patient’s own immune system attacks certain areas of the body) that can affect the thyroid gland, the tissues around the eye, or both.
The thyroid gland, located in the front of the neck, produces hormones that regulate your body’s metabolism (the process by which the body transforms food into energy). In Graves’ disease, the thyroid often is overactive. Some symptoms of an overactive thyroid are weight loss despite a good appetite, nervousness, rapid pulse, and sweating. The over-active thyroid can be treated with radiation or surgery.
Some eye problems associated with the disease are:
- Eye protrusion: This occurs when the muscles around the eyes swell, which pushes the eye forward. People with this condition looks as if they are staring.
- Eyelid retraction: The muscle that raises the eyelid becomes inflamed and/or over-active. The eyelid rises above the top of the colored part of the eye (iris). This worsens the cosmetic appearance of the eye protrusion and vice-versa. You can get lid retraction from an over-active thyroid alone, even without Graves’ disease.
- Dry eye: Because of protrusion and eyelid retraction, the eyes are more exposed to the air. This causes blurred vision, light sensitivity, dry eye, excessive tearing, irritation, and inflammation.
- Double vision: Muscle swelling or scarring may cause double vision.
- Eyelid swelling: can cause the tissue around the eyes to bulge forward.
The eye problem that is most feared is compression of the optic nerve, the nerve that goes from the eye to the brain. Untreated, this can cause permanent loss of vision. It is important that patients with Graves’ disease report decreased vision to their eye doctor promptly.
Graves’ disease is diagnosed by blood tests and often a CT or MRI of the eye sockets (orbits).
These problems are treated by non-surgical and surgical methods. Non-surgical methods include taking steroid medications by mouth to control swelling and inflammation, wearing sunglasses to relieve light sensitivity, prisms in the eyeglasses to relieve double vision, and applying lubricating ointment to relieve dry eye. Surgical methods include repositioning the muscles that move the eye or raise the eyelid, removing scarred tissue, and relieving compression on the optic nerve to preserve sight. Surgery on the eyelids or eye muscles must wait until the disease becomes inactive and there is no change to the patient’s condition for six months.
It is important to note that cigarette smoking worsens the eye manifestations of Graves’ disease.