Thyroid (Graves) Eye Disease

One of the most common thyroid diseases is hyperthyroidism, manifested by an overproduction of thyroid hormones. It may result in some degree of eye difficulty most commonly caused by abnormal swelling of the soft tissues surrounding the eyes, and enlargement of the muscles that move the eyes and open the eyelids. As a result, the eyes may protrude forward due to retraction of the upper eyelids which forces the lids apart, causing an inability to fully close the eyelids, as well as exposure of an abnormally large portion of the eyeball.This results in wide, prominent eyes, a fixed staring expression, and infrequent blinking of the eyelids.

Some patients begin experiencing eye problems as soon as their thyroid becomes hyperactive. In other cases, changes develop slowly, sometimes not occurring until years after the beginning of abnormal thyroid activity. Symptoms include pressure around the eyes, double vision, excessive tearing, and irritation of the conjunctiva (the mucous membrane that lines the eyelids). In the early course of the thyroid disease, only one eye may be affected, but as the disorder progresses, both eyes may become involved.

Overexposure of the eyes during the day and an inability to completely close the eyelids at night can result in injury or damage to the cornea (the front of the eye). Dryness of the cornea can cause considerable discomfort and visual problems, such as blurred vision, foreign body sensation, or light sensitivity. As the muscles slowly enlarge, movement of the eyes may become restricted. This restriction in movement may cause misalignment of the two eyes, resulting in disabling double vision. If the swelling is severe, the pressure in the orbit can become extremely high. This can cause compression of the optic nerve, possibly leading to a slow loss of vision and even blindness if the condition is not corrected.

Medical treatment of the hyperactive thyroid gland may sometimes relieve the associated eye problems, but often it does not. In cases of mild eye problems, treatment is directed at minimizing the symptoms. Sleeping with the head elevated and using diuretics can reduce swelling. Topical ointments and artificial tears may soothe the eyes. The use of plastic shields at night can help prevent drying of the cornea if the eyelids cannot close during sleep. Tinted glasses with side guards will help protect the eyes.  Corticosteroids or orbital radiation may also be of benefit to selected patients.

The  eyes can usually be improved by reconstructive eyelid and/or orbital surgery. The particular surgical technique used will depend on the type and severity of the eye problems. Orbital decompression (removal of part of the bony orbit or fat that surrounds the eye to relieve pressure within the eye socket) can prevent damage to the optic nerve. It also allows the eyes to move back into a more normal position within the sockets. Eye muscle surgery, in which the enlarged muscles that control eye movement are repositioned, may be performed to properly align the eyes and correct the double vision.  Eyelid surgical procedures to adjust the position of the eyelids usually helps minimize retraction of the lids.  Removal of excessive orbital fat in the eyelids can improve the patient's appearance.   Dr. Levin will discuss these options with you.