Supporting Treatments For Graves’ Ophthalmopathy

Graves’ disease is an autoimmune disease characterized by an overstimulation of the thyroid gland. It is the leading cause of hyperthyroidism, which results from having too much thyroid hormone. 

Approximately 40% of those diagnosed with Graves’ disease develop eye problems¹ such as swelling, redness, and, in some cases, vision loss. 

This condition is termed Graves’ ophthalmopathy or thyroid eye disease. It results from inflammation of the tissues surrounding the eyes, likely due to the immune system mistakenly targeting these tissues. 

Most people will only develop mild Graves’ ophthalmopathy, of which supportive or natural therapies may be beneficial until the condition resolves with time. However, in some cases, more serious symptoms develop that often require surgery. 

Eye symptoms with Graves’ disease

Most sufferers of Graves’ disease only have mild eye symptoms, such as eyelid swelling and retraction, redness, dry and gritty eyes, light sensitivity, and pain when moving their eyes. 

However, approximately one in 10 people will develop more serious symptoms, including: 

• Bulging or protruding eyes caused by severe swelling of the eyelids

• Double vision, which occurs when the eyes are misaligned 

• Optic nerve damage

• Vision loss or blindness 

Conventional treatments for Graves’ ophthalmopathy

For moderate to severe Graves’ ophthalmopathy, steroids are the first line of treatment to reduce swelling in the tissues around the eyes. 

This may be coupled with radiotherapy, especially if the steroids don’t work. Both have side effects, which should be discussed with your doctor. 

Biological agents, such as Teprotumumab, are now becoming more frequently used. In sight-threatening eye disease, surgery is often needed. 

Supportive treatments for Graves’ ophthalmopathy 

Around two-thirds of patients with mild Graves’ ophthalmopathy spontaneously improve within six months.² Mild disease is often monitored, and generally, only supportive therapy is required. 

The following are the supportive treatments used for the condition.

Supplementing selenium intake

Consider asking your doctor whether you should try a selenium supplement. Selenium is a trace element found in water, soil, and food such as nuts, fish, beef, and grains.  

One study in Europe showed that taking 100μg of selenium supplements twice daily resulted in slower disease progression³ and improved eye movements. 

However, it is uncertain whether these European patients had low baseline blood selenium levels to begin with, as European soil is thought to be low in selenium. 

Whether selenium may be helpful to American patients, where we have selenium-rich soil, is not clear, and more research is needed. 

It is also not yet fully understood how selenium can help reduce the symptoms of Graves’ ophthalmopathy. 

Care must be taken when using selenium, as it can become toxic at high levels and may result in side effects such as fatigue, nausea, diarrhea, and joint pain.

Taking vitamin D

Research into vitamin D and Graves’ ophthalmopathy⁴ is an evolving area. The latest studies show that people who are vitamin D deficient⁵ and have Graves’ disease are more likely to suffer from Graves’ eye disease than those who have normal vitamin D levels. 

Supplementing with vitamin D may help reduce the risk of developing Graves’ ophthalmopathy and ongoing eye damage. 

Avoiding exposure to smoking

Smoking is a major contributor to disease severity⁶ and has been shown to increase the chance of developing eye problems by seven to eight times. It also worsens your responses⁷ to treatment. 

If you smoke, quitting is the single best action you can take toward helping reduce the symptoms of Graves’ ophthalmopathy. 

Secondhand smoke is also damaging to the cornea (the transparent front portion of your eye) and tear film and can disrupt natural lubrication. 

Quitting smoking and removing exposure to secondhand smoke will prevent further irritation to the eyes.

External treatment methods for eye relief 

In mild cases of Graves’ ophthalmopathy, you can use simple, non-invasive remedies to help find relief.

The main goal of external therapies is to reduce dry eyes and prevent damage to the cornea. Typical remedies include: 

Lubricating eye drops

These can lubricate gritty eyes and support proper blinking. Preservative-free drops provide a more natural treatment and reduce the risk of irritation. 

Cold compress

A cold compress can help minimize pain and swelling of the eyes. 

Taping eyes shut for sleep

Taping the eyes at bedtime can prevent the dryness that comes from having the inner eye exposed to the air for a long period (in cases where eyelid swelling stops eyes from closing). Ask your doctor how to tape your eyes correctly. 

Elevated head position at night

Higher pillows or multiple pillows are useful at night. Sleeping with the head in an elevated position can help drain fluid away from the face and reduce swelling.

Sunglasses

Sunglasses protect eyes that have become sensitive to light. Wraparound varieties will also protect from irritation caused by airflow across the eye surface. 

Fresnel prism glasses

These are plastic prisms that stick to the front of glasses to help wearers manage double vision. However, these only correct vision when you are wearing the glasses. 

Vision therapy

This is a practice performed under the guidance of a medical professional. Exercises are completed that retrain the brain-to-eye pathways and improve visual skills. 

The lowdown 

Although supportive treatments may provide relief for minor or moderate symptoms of Graves’ ophthalmopathy, you should always seek conventional treatments to stop the disease from progressing. 

This would especially include cases where you have difficulties with vision, as it can result in blindness unless you get prompt medical attention. 

Supportive treatments might be extremely useful for some but not for others, and benefits will depend on a person’s specific disease characteristics. Your doctor can help find the right treatment plan for you.