Thyroid Eye Disease
The eyes are often involved in people who have Graves' disease. The same antibodies that trigger hyperthyroidism attack the tissues of the eyes, causing inflammation, swelling, and bulging. These symptoms produce a condition called thyroid eye disease, or Graves' ophthalmolopathy or Graves' orbitopathy. It is also sometimes called exophthalmos.
Although the majority of people with Graves' disease have some eye involvement, the severity varies widely. In general, people who smoke tend to have greater eye involvement. Many people develop eye problems well in advance of hyperthyroidism, while others start having eye problems after they are diagnosed with Graves'. In some cases, you may have eye problems without hyperthyroidism.
In the absence of hyperthyroidism, however, many people mistake the symptoms of thyroid eye disease for infection or other eye problems. Symptoms of thyroid eye disease include:
Redness and irritation
Gritty sensation, itchiness, or watery eyes
Sensitivity to light or sun
Dry eyes
Lid lag, in which the upper eyelid is slow to close when your gaze is down
Wide-eyed stare
Bulging of the eyes
Double vision or diminished vision
All these symptoms are believed to be the result of an attack by the same antibodies that affect the thyroid. These antibodies appear to stick to eye muscles, causing them to swell and become inflamed. Once the eyes are inflamed, they may remain that way for months, even years.
Thyroid eye disease is most common in middle-aged adults. If it does occur in older adults, it can be more severe. The condition is rare in children and teens. Some people believe that stress plays a significant role in predicting who gets thyroid eye disease and the severity of it.
When it's mild, treating thyroid eye disease often focuses on symptom relief. Artificial tears sold in drugstores can help lubricate dry and irritated eyes as can cool compresses applied to the eyes. Relief also means taking steps to shield your eyes from irritating situations. Try to avoid bright sunlight and areas that are drafty, windy, or smoky, which can aggravate your eye condition. When you do go outside, wear wraparound sunglasses to shield your eyes from the light.
Alert
The use of RAI to treat hyperthyroidism may worsen thyroid eye disease in some patients. The worsening of the symptoms is most pronounced in people who smoke and in people with severe hyperthyroidism. It is also more likely in people who have previous eye problems and patients with high levels of autoantibodies. Some studies have suggested that steroids such as prednisone given before and after RAI can prevent worsening of eye symptoms.
At night, you may want to try sleeping on extra pillows or elevating the head of your bed, so you can reduce the swelling in your eyes. Place a humidifier in the bedroom to help minimize dryness. And drink plenty of water throughout the day to help your eyes stay hydrated.
If the disease becomes more severe, you may need a steroid such as prednisone to help reduce the pain, swelling, and inflammation. The use of steroids, however, must be closely weighed against the drug's side effects, which include weight gain and a higher risk for infection. Also, steroids do not correct bulging of the eyes.
In extreme cases, in which the swelling becomes severe, you may require surgery to correct the eyes. A procedure called orbital decompression surgery can sometimes help patients whose eyeballs are bulging so badly that they are at risk for vision loss. Before surgery, your surgeon will order an MRI to see the extent of your eye disease. The surgery involves removing bone from the eye socket in order to make room for the excess tissue. Another option is external beam radiation, which uses X-ray beams to reduce inflammation in the back of the eyes.
If thyroid eye disease causes serious cosmetic problems, you may want to consider plastic surgery to alter the appearance of the eyes. In some cases, eyelid surgery may be done to correct eyelids that no longer close properly, and eye muscle surgery may be considered to correct misalignment of the eyes. Double vision can also be corrected with the use of eyeglasses that contain a prism. Regardless of what you do to correct your eye problems, if you have Graves' eye disease, your endocrinologist and ophthalmologist will have to work closely together to decide your best course of treatment.
