What is Graves Ophthalmopathy?

Graves ophthalmopathy is an inflammatory disease of the eyes usually seen in patients with hyperthyroidism, where the thyroid gland is overactive. Patients with Graves ophthalmopathy can experience symptoms ranging from redness around the eyes to bulging eyes. Treatments can include icing, medications, and sometimes surgery. An ophthalmologist usually supervises care for this condition and will monitor the patient for signs of increasing severity and complications.

Patients with Graves ophthalmopathy usually have a specific thyroid condition called Graves disease. Graves disease is an autoimmune disorder caused by misdirected immune attacks on thyroid tissue. The immune system identifies a protein found on thyroid cells as alien and reacts to those cells, leading to swelling and inflammation. The same protein is found in the eye muscles, and many patients with Graves disease experience mild eye irritation as a result of low-level inflammation. Patients with severe Graves ophthalmopathy experience bulging eyes as the irritated muscles push the eye out of position.

Conservative treatments for Graves ophthalmopathy can include elevating the head at night to reduce swelling, using ice packs to address inflammation, and applying lubricating eyedrops to address dry eye and pain. Anti-inflammatory medications can also be useful for reducing the swelling and making the eye more comfortable in the socket. In severe cases, surgery to reshape the socket to accommodate the swelling may be necessary after other treatments have failed.

Patients with hyperthyroidism, particularly Graves hyperthyroidism, should be alert to eye pain and irritation. Vision changes are also a cause for concern, as they may reflect damage to the eye muscles making it harder to track visuals or focus. Symptoms like redness, swelling, tearing, and itching are all warning signs of Graves ophthalmopathy. This condition can stabilize and resolve on its own, but this is not always the case. Accessing treatment early can reduce the risk of complications, such as pushing the eye out of the socket.

Treating the underlying hyperthyroidism will not necessarily resolve Graves ophthalmopathy. The autoimmune reaction is still present, and while the thyroid hormones may return to normal, the immune system will continue to attack the muscles of the eye. People with a history of Graves disease who develop eye irritation should inform their doctors about their medical history, as this may be very relevant to diagnosis and treatment. Following guidelines for regular eye examinations will help patients identify issues like glaucoma, allergies, and vision changes early, when they are easier to treat.