Grave's disease is an autoimmune disorder that causes the thyroid gland to produce an excessive amount of thyroid hormone within the body. This overproduction creates more hormones than the body needs and causes many important bodily functions to speed up. The thyroid is a butterfly-shaped gland located in the front of the neck and controls metabolism, heart and nervous system functions as well as other metabolic functions. An overproduction of the thyroid hormone can lead to hypertension, weight loss, irregular heartbeat and eye problems.
In addition to other symptoms, Grave's disease may also cause a condition known as Grave's ophthalmopathy in which the immune system attacks the muscles and other tissue around the eyes. This causes an inflammation and a build-up of tissue around the eye, which in turn, may cause the eyeballs to bulge out. Additional eye-related symptoms caused by Grave's ophthalmopathy may include:
- Dry and irritated eyes
- Excessive tearing
- Swollen eyelids
- Double vision
- Light sensitivity
- Pressure or pain
- Difficulty moving the eyes
In rare cases, the pressure on the optic nerve caused by Grave's ophthalmopathy may cause vision loss.
Grave's Ophthalmopathy Treatment
It is important to note that treatment for Graves' disease may not improve the symptoms affecting the eyes, so the symptoms of Graves' ophthalmopathy may be treated separately. Depending on the severity of eye symptoms, there are several different treatment options available for treating Graves' ophthalmopathy. Mild eye irritation may be treated with eye drops and steroids, such as prednisone, which may be prescribed for pain or swelling. More severe cases may be treated with external radiation to reduce inflammation. Surgical methods may also be used if other treatment methods are unsuccessful. Surgical options include:
Orbital Decompression Surgery
This procedure is used to relieve excessive pressure on the eye. An incision is made in the covering of the optic nerve to allow the buildup of cerebrospinal fluid to drain and take pressure off the nerve. This can also reduce the bulging eye effect many patients with Graves' ophthalmopathy experience.
Corrective Muscle Surgery
In some patients with thyroid disease, the muscles do not align the eyes properly and this may lead to double vision. Surgery to correct eye muscle abnormalities involves detaching and reattaching muscles to realign the eyes and restore proper vision.
Eyelid Retraction Surgery
An eyelid retraction occurs when the eye muscle contracts and the tissues swell, resulting in a wide open or surprised look. Since a larger portion of the eye is exposed, irritation and dryness of the eyes are frequent problems. Depending on the location and severity of the retraction, grafting techniques may be used to strengthen and reposition the lid, or skin tissue and fat are relocated or removed to improve positioning.
Most patients find relief from distressing eye symptoms after receiving treatment.