Graves' Disease For Eyes: The Symptoms

Graves’ disease is an autoimmune disorder that occurs when the thyroid is overactive and produces too much hormone. It affects 0.5%¹ of the US population and is more common in females. Other factors, including genetics and other autoimmune disorders, can increase your risk of developing the disease.

Graves’ eye disease, also known as Graves’ ophthalmopathy or Graves’ orbitopathy, is a Graves’ disease complication that affects approximately 50%¹ of people with the condition. It can cause swollen or protruding eyes due to damage in the surrounding tissues. 

Other Graves’ symptoms include hyperthyroidism, skin abnormalities, weight loss, and a rapid heartbeat.

How does Graves’ disease affect the eyes?

The thyroid gland produces hormones from iodine that are essential for many of your body’s processes. 

In Graves’ disease, the immune system produces an antibody called thyroid-stimulating immunoglobulin which targets the thyroid and overstimulates hormone production.

In Graves’ eye disease, this antibody mistakenly attacks the cells surrounding the eyes, causing an inflammatory response. The exact reason for this is unknown, but it is thought that there are proteins in the affected tissues that mimic those in the thyroid gland causing them to also be targeted by the antibody.

This malfunction contributes to swollen eyes, a common Graves’ symptom.

In some extreme cases, the soft tissue becomes inflamed and expands. Since the tissue is limited by the eye socket, the eyeball and surrounding tissue are forced outwards.

Eye symptoms

Eye symptoms generally start to appear around the time of diagnosis or up to six months before or after.

Many patients only experience mild eye symptoms; however, in some cases more serious symptoms develop. Vision problems are less common and don’t usually occur until the disease has progressed. 

Mild Graves’ disease eye symptoms include:

• Eyelid retraction (occurs in approximately 90%² of cases)

• Light sensitivity

• Eyelid swelling and puffiness

• Gritty eyes and dryness

• Pain when moving eyes, especially upwards or downwards

• Watery eyes

Severe Graves’ disease eye symptoms include:

• Exophthalmos (proptosis) — bulging or swollen eyes that protrude outwards from the eye sockets (can affect just one eye or both and may prevent eyelids from closing)

• Restricted eye movements — caused by the swelling of muscles that control eye movement 

• Optic neuropathy — damage to the optic nerve (the nerve responsible for transmitting visual information from the eye to the brain) which could worsen if left untreated

• Exposure keratitis — damage to the cornea due to dryness or difficulty closing eyelids from swelling

• Double vision (diplopia) — caused by inflammation and swelling of eye muscles

• Loss of vision — most often due to optic neuropathy or exposure keratitis

How serious are Graves’ disease eye symptoms?

Although eye-related symptoms don’t always have serious health consequences, vision problems and disfigurement can reduce quality of life.

The impact of Graves’ disease eye symptoms can be cosmetic or functional, and they may cause discomfort.

Impaired vision can make even the simplest daily tasks challenging and has been linked to depression. Having severely protruding eyes can noticeably change your facial appearance, affecting self-confidence and social interactions.

A study³ demonstrated that mental health issues such as anxiety and depression were higher in patients with Graves’ eye disease compared to the general US population.

Another study found self-perception⁴ was lower in people with eye-related symptoms than those without.

When evaluating the psychological state of people with more severe symptoms, researchers⁵ found these individuals had higher levels of depression, anxiety, apathy, and anger compared to those with only mild to moderate symptoms. 

Early treatment is vital to prevent severe eye damage and restore healthy eye function. Treatment to improve the eyes’ appearance can also help to significantly improve your emotional wellbeing, as disfigurement is thought to have the most significant psychological impact.

Who is at risk of developing eye symptoms?

Multiple factors can increase your chance of developing eye symptoms with Graves’ disease, including: 

Age and sex

Research⁶ shows that older people and males experience more severe eye symptoms.

Smoking

Smoking⁷ increases your risk of developing eye symptoms by seven to eight times and can make them worse. The number of cigarettes⁸ smoked per day has been found to directly influence symptom severity.

Studies⁹ have also shown that smoking is linked to disease progression and can decrease the effectiveness of treatment.

Nutrition

You may be more at risk of developing Graves’ eye disease if you have a selenium deficiency¹⁰ or high cholesterol levels.¹¹

Treatments to relieve Graves’ disease eye symptoms

Since the majority of eye symptoms are mild, simple remedies can reduce swelling and relieve pain, including: 

• Applying eye drops for gritty eyes

• Elevating your head at night to minimize swelling

• Taping eyes at night to prevent them from becoming dry

• Applying a cool compress to help with pain and swelling

• Wearing sunglasses to protect from light sensitivity

• Wearing prism glasses to manage double vision

• Taking selenium supplements (selenium is used by the body as an antioxidant to reduce oxidative stress caused by the disease)

• Taking glucocorticoids (work by targeting inflammation in eye tissues)

Your doctor might suggest surgery in severe cases or when initial treatments haven’t successfully improved your symptoms.

Types of surgery include:

• Eyelid surgery to protect the eyes by enabling them to close properly

• Eye muscle surgery to alleviate double vision

• Optic decompression surgery — this is performed to relieve pressure on the optic nerve and reduce disfigurement from protruding eyes by increasing the space behind the eyeballs (this is a risky procedure and is typically only recommended for those with or at risk of vision loss)

The lowdown

Eye problems caused by inflamed tissues and cells surrounding the eyes are one of the major symptoms of Graves’ disease.

These symptoms are rarely a major cause for concern, but some people experience low self-esteem and depression as a result of disfigurement or vision problems. Speak to your doctor as soon as possible if you experience eye symptoms as treatment can stop them from worsening and affecting your quality of life.