In most cases, Graves' Disease is associated with hyperthyroidism (over-active thyroid gland). The muscles and fat tissue behind the eye become inflamed, causing the eye to protrude from the orbit. This finding is called proptosis or exophthalmos, and the eye involvement in Graves' Disease is called Graves' Ophthalmopathy or Graves' Orbitopathy.
Active progression of Graves' ophthalmopathy usually continues over a 6-24 month period before stabilizing. In order to monitor the progression of Graves' disease, an ophthalmologist will measure the amount of proptosis (bulging of the eye) and eyelid retraction.
When the eye muscles become swollen, inflamed and tight, eye movement may be restricted, which can cause double vision. As the eyes protrude and the eye lids retract, the corneal surface may become dry, rough, and irregular from exposure. Since the eyelids help keep the tear film evenly distributed over the surface of the eye, when the lids are unable to completely cover the corneal surface, and the eye dries out, discomfort and vision loss can occur.
In severe cases, significant disfigurement may be experienced due to proptosis and periorbital swelling. Patients may also have functional difficulties including double vision, corneal exposure, or possible vision loss from compression of the optic nerve.
Thyroid ophthalmopathy can be sight threatening. Treatment is essential. The ophthalmologist will assess and treat the patient's individual symptoms. Some treatment options may include:
- Prisms in eyeglasses as a treatment of small amounts of double vision.
- Artificial tears and other lubricants to treat corneal exposure.
- If swelling around the eye lids occurs, elevating the head of the bed or using two or more pillow may help.
- Eyelid, eye muscle, or orbital decompression surgeries are necessary in some patients with Graves' Ophthalmopathy.