Thyroid Eye Disease: Graves' Opthamolopathy

Symptoms and Treatment for Protuberant and Irritated Eyes

Using eyedropper to treat irritated eyes
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People with thyroid disease may develop an eye condition when the immune system cells attack the muscles and other tissues around the eye. The inflammation can cause the eyeballs to bulge out. Rarely, it can rarely be severe enough to cause vision loss.

There are many different names you might find for the autoimmune eye condition that is often seen in people with thyroid disease. These names include: 

  • Thyroid eye disease, sometimes abbreviated as TED
  • Graves' opthamolopathy (GO)
  • Thyroid-associated orbitopathy (TAO)
  • Grave's orbitopathy

Cause

Thyroid eye disease is an autoimmune eye condition that, while separate from thyroid disease, is often seen in conjunction with Graves' disease. About 25 to 30 percent of people with Graves' disease have a mild form while only a tiny percentage develop a severe form.

The condition, however, is seen in people with no other evidence of thyroid dysfunction, and occasionally in patients who have Hashimoto's disease. Most thyroid patients, however, will not develop thyroid eye disease, and if so, only mildly. Smoking is associated with a worsening of the symptoms.

Signs and Symptoms

Those with thyroid eye disease may have these signs:

  • Pain in the eyes when looking up, down, or sideways
  • Dryness, itching, dry eyes, difficulty wearing contact lenses
  • Inflammation and swelling of the eye and its surrounding tissues
  • Swelling in the orbital tissues which causes the eye to be pushed forward, referred to as exophthalmos, which can make people with thyroid eye disease appear to have a wide-eyed or bulging, protuberant stare.
  • Bloodshot eyes
  • Double vision (diplopia)
  • Light sensitivity
  • Impaired vision
  • Difficulty moving the eyes

    Thyroid eye disease is known to go through varying degrees of severity and can go into periods of remission. It often lasts one to two years. When it has been inactive for a period of around a half a year, it's less likely to recur.

    Treatment 

    For a mild case, you can use lubricating eyedrops and ointments, artificial tears, and avoid wind and bright light. If you have severe symptoms, your doctor may prescribe corticosteroids such as prednisone to reduce the swelling.

    In a very small percentage of patients, orbital decompression surgery may be recommended. This procedure removes the bone between the eye socket and the air sinus behind it so your eye has more room. This can improve your vision but there is a risk of double vision.

    Double vision can also occur when scar tissue from the ophthalmopathy makes an eye muscle too short. Eye muscle surgery can be done to attach the muscle at a point where it will again be the correct length to provide single vision. However, more than one surgery may be needed to get it right.

    Living With Thyroid Eye Disease

    Be sure to wear sunglasses as your eyes will be more sensitive to sun and wind and more vulnerable to ultraviolet rays. You may also try elevating the head of your bed to help relieve the pressure and swelling.

    Cool compresses may also help provide relief.

    Sources:

    Graves' Disease. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/endocrine-diseases/graves-disease.

    Hyperthyroidism (Overactive Thyroid). Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/hyperthyroidism/basics/definition/CON-20020986?p=1.

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