What Eye Problems Does Graves' Disease Cause?

Graves’ disease is a disorder that causes your thyroid gland to make too much of certain hormones -- a condition called hyperthyroidism. In addition to weight loss, a fast heartbeat, high blood pressure, and crankiness, among other symptoms, it also can cause your immune system to attack healthy cells by mistake. In some people, the muscles and tissue around the eyes are targeted.

About half of people with Graves' disease notice some eye issues, and some have severe vision problems. Experts think this happens because the tissues in your eyes have proteins like ones in your thyroid gland. The problem is known as Graves' eye disease or Graves' ophthalmopathy.

Doctors don't think it can be prevented, but you're more likely to get it -- and have a worse case of it -- if you smoke.

Symptoms

Graves' ophthalmopathy can cause a wide range of issues with your eyes. Some people might have a little redness and minor pain, while others have strong swelling, dryness, and more severe pain. It’s also possible to have bulging eyes -- because your muscles swell and your eyes are pushed out -- and pressure may build up in your eye socket. In rare cases, you can have double vision or other problems with your sight.

Most people with the condition notice eye symptoms within 6 months (before or after) of being diagnosed with hyperthyroidism. People who have severe hyperthyroidism aren't necessarily more likely to have eye trouble than those who have milder cases.

Diagnosis

If you think you may be developing Graves' ophthalmopathy, you may need to see an endocrinologist (a doctor who specializes in problems with hormones) and an ophthalmologist (eye doctor). If you know you have Graves', your doctor should be able to find out if you have the eye problem with a standard eye exam.

In some cases, you may need blood tests, or imaging tests like a computerized tomography (CT) scan or a magnetic resonance imaging (MRI) scan. With a CT scan, X-rays are taken from different angles and put together to make a more complete picture. And an MRI uses powerful magnets and radio waves to make detailed images.

If you haven't been diagnosed with Graves' disease, step one probably will be to get your thyroid hormone levels checked with a simple blood test.

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Treatment

The first step would be to reverse the hyperthyroidism with either medication or surgery to remove the thyroid.

A number of things can also help with dry eyes: The biologic teprotumumab (Tepezza) has been newly approved to help treat Grave’s eye disease. Also, artificial tears, gels, and ointments.

If you have a lot of swelling -- especially if it leads to double vision or loss of vision -- you might need to take a steroid called prednisone for a few weeks to bring the swelling down. If the first doses don't work, the next step would be a new medication approved for thyroid eye disease.

In urgent cases to prevent vision loss, your doctor may surgically remove some tissue from your eye socket or do radiation therapy, where high-energy X-rays are aimed at the eye muscle.

Graves' ophthalmopathy tends to get better after a few years, but you may have other eye problems that need to be corrected with surgery. For example, you might need surgery to ease pain and pressure on your optic nerve, fix the alignment of your eye muscles, or make sure your eyelids cover and protect your eyes.

WebMD Medical Reference Reviewed by Michael W. Smith, MD on November 04, 2020

Sources

SOURCES:

American Thyroid Association: "Graves' Disease," "Hyperthyroidism (Overactive)."

New England Journal of Medicine: "Graves’ Ophthalmopathy."

Medical Clinics of North America: "The Evaluation and Treatment of Graves Ophthalmopathy."

University of Michigan Kellogg Eye Center: "Thyroid Eye Disease (TED or Graves Eye Disease)."

FDA: "FDA approves first treatment for thyroid eye disease."

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