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Oculoplastic Surgery

Thyroid Eye Disease

Thyroid eye disease, otherwise known as Graves orbitopathy (GO) is an autoimmune process affecting the eyes and orbit that is frequently seen in people with overactive thyroid glands. As many as 50 percent of those with hyperthyroidism (Graves disease) will show some signs of Graves orbitopathy and about 5 percent will have a severe form which can threaten eyesight. Graves orbitopathy can also be seen in people with underactive thyroid glands, or without thyroid problems at all, but this is much less common.

The most common sign of Graves orbitopathy is eyelid retraction. This gives the eyes the appearance of being more widely open than normal. The eyes may become red and swollen and the orbital muscles and fat may also become enlarged, leading to bulging of the eyes, misalignment, double vision, dry eye, and sight-threatening compression of the optic nerve. Symptoms of Graves orbitopathy include pressure behind the eyes, pain or pressure on eye movement, double vision, decreased vision, or a gritty or dry sensation.

The inflammation seen with Graves orbitopathy usually lasts around six months to two years, but most of the effects on the orbit are permanent. Therapy focuses on decreasing the inflammatory phase and proactively limiting the damage it produces. This is done with steroids, radiation, or other anti-inflammatory medications.

Once the inflammation is controlled, surgery can be performed to reduce the bulging of the eyes, straighten and realign the eyes, and return the eyelids to their normal position and appearance. Often patients have to undergo multiple surgeries in order to repair the damage that has been done.

It is important that everyone diagnosed with thyroid disease with new eye symptoms be evaluated as soon as possible. If therapy is needed, it is best to begin this early.