What is Graves’ Eye Disease

Graves’ eye disease (GED) often associated with Graves’ disease, is an eye disorder also called thyroid eye disease or Graves’ ophthalmopathy. Graves’ disease is an abnormal functioning of the immune system that stimulates the thyroid gland in the body to overproduce thyroid hormone (hyperthyroidism). It happens due to the abnormality of the immune system which affects other tissues and muscles of the body specifically around the eye area. The condition leads to the swelling of fatty acids and eye muscles behind the eyes and causes them to bulge out. Although, there is no vision loss but a person may feel severe irritation. It is observed that the disease often disappears by itself. This article covers the whole information about the causes, symptoms and diagnosis, and especially focuses on the treatment of Thyroid eye disorder.

Causes of Graves’ Eye Disease

The causes of graves’ eye disease are not completely discovered. The disease is also found in individuals who are apparently not suffering from hyperthyroidism. Research shows that Graves’ eye disease occurs in 25-50% of the patients already suffering from Graves’ disease. However, it is found that the disease is associated with the abnormality of the immune system that promotes the functioning of thyroid-stimulating immunoglobins (TSI). These TSI instead of influencing the thyroid gland cause inflammation of tissues and muscles around the eye sockets.

Other major Graves’ eye disease causes are:

1. Genetic Tendency

A person with a genetic history of autoimmune or thyroid disorders is more likely to suffer from Graves’ eye disease.

2. Smoking

Smoking is the major cause that exaggerates the symptoms of Graves’ eye ophthalmopathy. Smokers with Graves’ disease have a greater tendency to develop severe symptoms of Graves’ eye disease.

3. Age and Gender

Its symptoms are likely to be found in middle-aged females. The disease is rare in males but symptoms are comparatively worse than in females.

4. Iodine Radiation Therapy 

Patients with Graves’ disease often go through iodine radiation therapy. Radioactive iodine causes more severe symptoms of Graves’ eye disease in individuals already suffering from eye disorders.

Symptoms of Graves’ Eye Disease

Graves’ eye disease symptoms depend upon the severity of the disorder. There are no specific or common symptoms of Graves’ disease and all individuals don’t face the same signs. The major Graves’ eye disease symptoms are:

1. Bulging eyes

Abnormal protrusion of eyelids due to the accumulation of liquid in eye fat and muscles around it is the most common symptom of Graves’ eye disease.

2. Eye irritation 

It is common to feel redness, itching, burning, or irritation during Graves’ eye disease. Dryness and tear formation may also occur due to this gritty feeling.

3. Double vision (Diplopia)

Sometimes misalignment of eyelids occurs and causes double vision. Individuals feel extreme difficulty while moving their eyes during daily life activities.

4. Pain or pressure 

An individual suffering from the disease feels extreme pressure behind the eyelids which causes severe pain. It becomes more uncomfortable during eye movement.

5. Eyelid Retraction

Eyelid retraction is a staring appearance in which the sclera, the white part of the eye is more visible, and the upper eyelid seems higher than normal. 

6. Sensitivity to light

A person suffering from Graves’ eye disease becomes sensitive to light. Exposure to light for such people causes extremely uncomfortable pain in the eyelids.

7. Trouble during Eye movement

An individual has to endure extreme trouble and pain while moving his eyes because of the inflammation around the orbits of the eyes.

Diagnosis of Graves' Eye Disorder

The diagnosis of Graves’ eye disease involves several diagnostic tests and a proper medical evaluation. 

1. Physical Examination

Diagnosis of Graves’ disease begins with a physical examination of the eyes to detect any inflammation, protrusion, or abnormal movement of the eyelids. The genetic and prior medical history of thyroid gland functioning in the body is also keenly observed by clinical experts.

2. Thyroid Function Test

The activity of the thyroid in the body is determined through the measurement of TSH (thyroid stimulating hormone) and thyroid hormones (T3 and T4)) in the blood through a blood test called thyroid function test. 

3. Imaging Studies

If symptoms of Graves’ eye disease are detected in the thyroid function test, doctors study the severity of the disease through ultrasound, MRI, and CT scans. These imaging techniques can also help in determining optic nerve compression.

4. Ophthalmologic Examination

It is a comprehensive eye test in which the doctor examines eyelid movement, the extent of protrusion, the severity of the inflammation, and other eye discomforts. Any kind of peripheral vision loss is also determined through a visual field test.

Treatment of Graves’ Eye Disease

Graves’ eye disease treatment includes medication, radiotherapy, surgery, precautionary measures, and other methods which are discussed in the next section. The main purpose of the treatment is to alleviate pain, irritation, and discomfort but its effectiveness depends on the extremity of the complicated situations.

1. Medication

Anti-inflammatory drugs like Corticosteroids are highly beneficial in treating severe inflammation. But its high consumption is very harmful. If corticosteroid fails to work effectively, one can also use Immunosuppressive Agents, to suppress the response of the immune system. A more effective drug Teprotumumab is also introduced that specifically treats Graves’ eye disease by inhibiting the activation of insulin-like growth factor-1 (IGF-1) receptors, which directly contributes to worsening the symptoms of Grave’s disease. Orbit radiotherapy helps to reduce inflammation around the eye orbits. It is an effective treatment when medication is not enough to treat the severity of the disease. 

2. Surgery

Surgery is done in extreme cases of Graves’ ophthalmopathy especially when there is a threat of vision loss and, increased optic nerve compression and deformity. There exist several surgical options to cure graves’ ophthalmopathy. Orbital Decompression Surgery involves the removal of bone from the orbit to minimize the pressure on the optic nerve and create space for the swollen tissues. It causes eyes to go back to their original or natural placement. Strabismus Surgery is another type of surgery that is used to cure misaligned eyes and double vision by fixing them to their natural space. Eyelid Surgery is another alternative to treat eyelid retraction by improving the proper functioning and overall vision of the eyes and minimizing enlargement of the eye muscles and fat.

3. Lifestyle Modification

Lifestyle modification includes quitting smoking, protecting eyes from direct sunlight by wearing sunglasses or a helmet and using lubricating eyedrops to prevent irritation and dryness. Keeping your head elevated may also help to reduce swelling around your eye muscles.

Can Graves' eye disease eyes go back to normal?

It is normally believed that graves’ eye disease is 100% curable and the eyes go back to their original state but it depends upon the severity of the disease and the proper functioning of the immune system and thyroid hormones in the body. It may take six months to one year to cure it completely. Although there isn't a proper or fixed cure for Graves' ophthalmopathy, but improvements in medical care and surgical methods provide hope for better outcomes and a complete treatment for the patients who suffer from this difficult condition. The secret to effectively managing Graves' eye illness is early intervention, lifestyle changes, and a multidisciplinary strategy comprising endocrinologists, ophthalmologists, and other medical specialists.