Eye Disorders: Thyroid Eye Disease, also known as Graves Ophthalmopathy
Thyroid Eye Disease (also called Graves eye disease or Thyroid Related Immune Orbitopathy) is an inflammation that involves the orbital tissues (located around and behind the eye). The cause of the inflammation is an autoimmune process (the immune system is inappropriately attacking the body). Thyroid disease, like Graves disease, is often associated. However, thyroid eye disease can rarely occur without an associated thyroid abnormality.
What symptoms may occur?
The inflammation may involve the eye muscles, fat behind the eye, the lacrimal (tear) gland, as well as the front of the eye and eyelids. Depending on what tissues are involved, there can be many different symptoms:
1. Eye muscle involvement often leads to eye misalignment and double vision.
2. Involvement of the fat behind the eye leads to protrusion of the eye (proptosis, or exophthalmos).
3. Levator (eyelid muscle) retraction may cause a wide-eyed stare.
4. Lacrimal gland involvement may lead to a dry eye
5. Involvement of the tissues around the eye can lead to swollen lids
6. Involvement of the eye surface can cause redness.
7. Rarely, permanent vision loss may occur if enough pressure is exerted by inflamed tissues on the optic nerve behind the eye.
What treatments are availabe?
The underlying thyroid disease should be optimally treated, resulting in normal Free T4 levels. Treatment of the orbital disease is tailored to the specific manifestations. Initially treatments are supportive, with eyelid lubrication for dryness, eyeglass prisms for diplopia, topical prednisone for red eyes, and perhaps a course of oral prednisone depending on severity. Tobacco users have worse orbital disease, so that should be stopped. A controversial treatment option is orbital irradiation.
The disease typically goes through an active inflammatory stage for 2-3 years, during which time symptoms can fluctuate, then quiets down. When the disease is in the quiet phase, there are several surgical options to correct protruding eyes, eye misalignment, and eyelid retraction.
The North American Neuro-Ophthalmology Society publishes a web site with good patient information on this condition