Graves’ Eye Disease

Graves’ eye disease is caused by the same immune response as Graves’ disease. You can find out about both conditions below.     

What is Graves’ Disease?

Graves’ disease is an autoimmune disorder where the immune system attacks your thyroid gland. The thyroid responds by producing too much thyroid hormone (or hyperthyroidism). Graves’ disease is not the only cause of hyperthyroidism, but it is one of the most common. Women are more likely to develop the condition than men, especially younger women. 

Because the thyroid is so important in so many of the body’s systems, overactive thyroid symptoms (or hyperthyroidism symptoms) can come in many forms. Graves’ disease symptoms include:

•   nervousness,

•   muscle weakness,

•   shaking in your hands,

•   a swelling at the bottom of your neck (an enlarged thyroid or goitre),

•   unexplained weight loss,

•   a racing or irregular heartbeat (palpitations),

•   increased sweating,

•   problems with sleep,

•   frequent bowel movements or diarrhoea,

•   changes in your period for women and erectile dysfunction in men,

•   loss of sex drive (low libido).

Graves’ disease can affect your eyes (Graves’ eye disease) and in rare cases it can affect your skin, usually on the front of the legs (Graves' dermopathy). 

What is Graves’ Eye Disease?

Graves’ eye disease or thyroid eye disease (TED) is caused by the same immune response as Graves’ disease. This can affect the tissue and muscles around the eyes causing inflammation and swelling, causing Graves’ eye disease.

Symptoms of Graves’ eye disease are often mild and treatable. They can include:

•   bulging eyes (proptosis), 

•   redness or inflammation, 

•   pressure or pain in your eyes,

•   a feeling of grittiness in your eyes,

•   puffiness around the eyes including swollen eyelids, 

•   increased sensitivity to light (photophobia),

•   double vision (diplopia),

•   in rare cases some form of vision loss.

Graves’ Eye Disease Diagnosis

The exact cause of Graves’ eye disease isn’t clear. Research suggests that it’s probably due to a combination of genetic and environmental reasons. Anyone can develop it but women are at a higher risk than men. 

If you already have a diagnosis of Graves’ disease, a doctor can diagnose Graves’ eye disease via an eye examination. 

If you don’t have a Graves’ disease diagnosis, your doctor will also check your neck to see if your thyroid is enlarged and may request blood tests. They may also request tests such as ultrasound, CT scan, or MRI to get a detailed look at your thyroid gland. 

Graves’ Eye Disease Treatments

If you are experiencing eye problems, you'll probably be referred to an ophthalmologist for treatment. While treating hyperthyroidism and Graves’ disease can help, usually the eye disease needs specific treatment.

Graves' eye disease can be divided into two stages. During the active stage, the symptoms are present and your vision may be at risk without proper treatment. It can last for several months up to two years1 but often symptoms settle down after around 6 months. (2) The inactive phase means the condition has settled down but you may have some long-term problems, for example protruding (bulging) eyes. (3)

Treatment will depend on the symptoms, stage and the underlying health condition, and may include:

•   Hyperthyroidism treatment including medication to correct thyroid hormone levels,

•   Eye drops to reduce inflammation, 

•   Special prism glasses to correct double vision,

•   Steroid injections to control inflammation,

•   Radiotherapy to help with swelling,

•   Surgery to help with long term eye bulging (exophthalmos).

Citations

1. https://www.nhs.uk/conditions/bulging-eyes/treatment/

2. https://www.healthline.com/health/graves-disease-eyes#outlook

3. https://www.nhs.uk/conditions/bulging-eyes/treatment/