What Is Graves’ Eye Disease?

Graves’ disease is typically known as a thyroid condition. However, this disease can impact many parts of the body, including the eyes. Graves’ eye disease is characterized by inflammation and swelling around the eyes and changes in vision.

Graves’ disease

Graves’ disease is a type of hyperthyroidism, which indicates an overactive thyroid gland. The symptoms are often mild and treatable.

It affects about 1 in 100 Americans. As a result of being overactive, the thyroid produces too many hormones and releases them into the blood. 

Graves’ disease is different from other types of hyperthyroidism because it’s caused by autoimmunity. Thus, the immune system mistakenly attacks the thyroid, which increases hormone production.  

The hormones produced by the thyroid are:

• triiodothyronine (T3)

• tetraiodothyronine (thyroxine or T4)

• calcitonin

The T3 and T4 hormones, in particular, are involved with many processes in your body. These include:

• regulating metabolism

• growth and brain development

• regulating body temperature

• regulating heartbeat

• activation of the nervous system

Due to the many processes that the thyroid hormones are involved with, it’s clear why Graves’ disease is not limited to the thyroid only.

Several complications of Graves’ disease can occur, such as:

• ophthalmopathy (eye problems)

• dermopathy (skin problems)

• thyrotoxic myopathy (muscle problems)

• goiter (bulging neck)

Graves’ disease worsens when left untreated, as new symptoms or complications can develop. 

Graves’ eye disease typically occurs within the early stages of this condition or concurrently with other symptoms of hyperthyroidism. There is also potential for Graves’ eye disease to occur after Graves’ disease is treated. 

Graves’ eye disease is characterized by puffy, swollen, and inflamed tissue around the eyes. Blurred or double vision can also occur, along with other symptoms such as a gritty sensation in the eyes and light sensitivity. 

Therefore, it is crucial to seek medical advice early if you notice any symptoms of Graves’ disease. Early intervention can significantly improve your outcome and quality of life. 

Symptoms of Graves’ disease

Because Graves’ eye disease is an early manifestation of Graves’ disease, you may experience a variety of symptoms.

Here is a list of the general symptoms associated with Graves’ disease, though you’re unlikely to encounter every symptom. Also, this disease affects everyone differently.

Symptoms can include:

• weight loss

• increased appetite

• irregular heart rate

• rapid heart rate

• nervousness

• restlessness

• difficulty sleeping

• daytime tiredness

• fatigue

• menstrual changes

• frequent or irregular bowel movements

• muscle tremors and weakness

You should also know that Graves’ eye disease can occur even when no other apparent problems linked to hyperthyroidism are present. Some people have developed Graves’ eye disease despite having a normally functioning thyroid.

Therefore, you should not assume that you don’t have Graves’ eye disease if no other symptoms are present. However, being aware of the overall illness will help you identify any other symptoms that might occur. 

Graves’ ophthalmopathy

Graves’ ophthalmopathy is the medical term for Graves’ eye disease. But many people still refer to it as Graves’ eye disease. 

Most cases of Graves’ eye disease have common symptoms that include:

• bulging eyes

• irritated eyes

• puffiness around the eyes

• redness around the eyes

• sensitivity to bright light

• painful pressure in the eyes

• blurred vision

• double vision

• difficulty closing eyelids

As mentioned, Graves’ eye disease often occurs quite early, when Graves’ disease first develops. Therefore, it’s important to be aware of these symptoms. 

If Graves’ eye disease is left untreated, you may develop new complications, such as vision loss. Because of this, it’s essential to get this condition treated as soon as possible. 

How to alleviate symptoms

Some over-the-counter products and other solutions are available for you to try. However, these treatments should not replace other therapies recommended by your doctor. 

Use eye drops

Many people with Graves’ disease report that they have difficulty blinking. Lubricating eye drops can help alleviate this problem. 

Elevate your head

Elevating your head with extra pillows while you’re resting or sleeping might help. Make sure that your head is elevated at least 15 degrees, or position your head at a higher level than your chest. Doing so might reduce some of the fluid that accumulates around your eyes. 

Use Fresnel prisms

Fresnel prisms are plastic inserts in the shape of a prism that you can put on your glasses. These are ideal for people who are experiencing double vision. 

Wear sunglasses

Another common issue with Graves’ disease is sensitivity to light. Sunglasses may reduce this sensitivity and will alleviate other forms of eye irritations when you’re outdoors. 

Tape your eyelids while sleeping

If you notice that your eyes feel particularly dry when you wake up in the morning, you could apply some gentle tape over your eyes before you sleep to reduce dryness.

Alternatively, you could apply some tape temporarily during the day for at least ten minutes for some additional relief if your eyes feel too dry. 

Ask your doctor or pharmacist for a medical-grade tape that would be safe to cover your eyes to prevent further irritation from occurring. 

Avoid smoking

Smoking is known to make the symptoms of Graves’ eye disease considerably worse. Studies¹ have shown that people who smoke have poorer treatment outcomes compared to those who do not. Therefore, quitting cigarettes will aid the recovery process. 

Treatment

In most cases, Graves’ eye disease is a self-limiting disease, which means the inflammation will gradually go away by itself. However, there are some treatments available to help manage your symptoms.

Unfortunately, some aspects of this disease cannot be reversed through treatment or surgery. Sometimes the disease can make noticeable changes to the face that cannot be altered or reversed completely. 

Several treatment approaches are available that you can try. For example, some treatments aim to address this eye disease as it flares up, whereas other therapies target the underlying Graves’ disease instead. 

Medications

If you’re experiencing a flare-up of Graves’ eye disease, your doctor might put you on monoclonal antibodies and corticosteroids. 

Tepezza, also known as teprotumumab, is a monoclonal antibody treatment for Graves’ eye disease. However, monoclonal antibodies only temporarily reduce the problems; they aren’t a long-term solution for managing your condition. 

Corticosteroids are a treatment that reduces eye inflammation, and they alleviate many symptoms that occur when Graves’ eye disease flares up. However, like the monoclonal antibodies, corticosteroids are not a cure and only reduce the severity of the symptoms you’re experiencing. 

It might be worth trying long-term therapy after your flare-up has been managed to treat the underlying Graves’ disease. Long-term treatments might include other medicines, such as antithyroid medications designed to stop the production of new thyroid hormones or beta-blockers and reduce symptoms of hyperthyroidism.

Researchers² have also discovered that 100 mcg of selenium twice daily can provide some benefit to those with Graves’ eye disease. Selenium can help because it is a powerful antioxidant that will alleviate the oxidative stress related to Graves’ eye disease.

However, beware that many treatments for Graves’ disease may not reduce or prevent eye disease. 

Radioactive iodine therapy

Radioactive iodine therapy can worsen Graves’ eye disease, and this treatment is not recommended for people with moderate or severe cases. However, it could be an initial treatment option for people who have mild eye disease to use alongside other therapies. 

Surgery

For severe cases of Graves’ eye disease, some surgical procedures can be performed to correct vision or improve bulging eyes. There are other surgical options available depending on what you might need. 

If you are having trouble closing your eyes, then eyelid surgery could potentially help. With eyelid surgery, your eyelid can be surgically repositioned to ensure it closes more easily. 

The muscles around your eye can also be operated on to correct double vision.

Orbital decompression surgery is a type of surgery that is reserved for severe cases in which eyesight is becoming seriously compromised. This procedure removes a bone between the eye socket and sinuses to create more room for the swelling that occurs. However, there are some complications from this surgery, such as persisting double vision. 

When to see a doctor

Visit your doctor if you’re experiencing any problems with your eyes. Protecting your eyesight is crucial to avoid impaired vision. Your doctor can refer you to an ophthalmologist for further advice and treatment. 

Be sure to return to your doctor or ophthalmologist if your current treatment isn’t working. If this is the case, it might be time to try something new. 

Don’t hesitate to tell your doctor about any other Graves’ disease symptoms you have developed as well. 

The lowdown

Graves’ eye disease is a complication of Graves’ disease. If you’re experiencing any eye problems, you need to seek medical attention as soon as possible. 

Several treatments are available to help manage Graves’ ophthalmopathy and Graves’ disease. Be sure to consult your healthcare team for the best advice.