Graves’ Disease

Graves’ disease is an autoimmune disorder that leads to overactive thyroid gland (hyperthyroidism). It is caused by an abnormal immune system response which prompts the thyroid gland to produce too much thyroid hormone. Graves’ disease is most common in women over age 20. However, the disorder may occur at any age and may affect men as well

Typical treatments for Graves’ Disease are:

  • Antithyroid medications
  • Radioactive iodine
  • Surgery

Dry Eyes and Graves’ Disease

Dry eye syndrome is very common amongst people with Graves’ disease. It is also called “thyroid eye disease”.

Thyroid eye disease is known to go through varying degrees of severity, and it can go into periods of remission as well. When it has been inactive for a period of around a half a year, it’s less likely to recur.

Dry Eye Symptoms in Graves’ Disease

  • Pain in the eyes, pain when looking up, down or sideways
  • Dryness, itching, dry eyes, difficulty wearing contact lenses
  • Inflammation and swelling of the eye, and its surrounding tissues
  • Swelling in the orbital tissues which causes the eye to be pushed forward — referred to as exophthalmos — which can make thyroid eye disease sufferers appear to have a wide-eyed or bulging stare.
  • Bloodshot appearance to eyes
  • Double vision (diplopia)
  • Impaired vision

Treatments for Dry Eyes in Graves’ Disease

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In milder cases of thyroid eye disease, typical treatments for dry eye syndrome work well. These include but are not limited to:

  • TheraLife┬« Eye Autoimmune
  • Wrap-around sunglasses to avoid glare
  • Room humidifiers
  • Prism lenses in eye glasses to reduce double vision.
  • Short course of Prednisone to address eye swelling and redness

You may need to tape your eyes closed at night to prevent drying. Sunglasses and eye drops may reduce eye irritation. Rarely, surgery or radiation therapy (different from radioactive iodine) may be needed to return the eyes to their normal position.

Some doctors recommend orbital radiation, which can be successful in some patients.

In rare cases, when medical treatment has not resolved the retracted and puffy eyelids, or double vision, doctors will recommend corrective surgery.

Eyelid surgery is primarily cosmetic in nature, and is designed to bring the eyelids into a more normal position, to improve appearance.

Surgery for double vision works with the muscles that control eye movement.

In a very small percentage of patients, the swelling in the orbital area impairs vision by pressing on the optic nerve. In these cases, a surgery called orbital decompression is needed in order to prevent severe complications.

Some of the eye problems related to Graves’ disease usually improve when hyperthyroidism is treated with medications, radiation, or surgery.

Radioactive iodine can sometimes make eye problems worse. Eye problems are worse in people who smoke, even after the hyperthyroidism is cured.

The Issue of Radioactive Iodine Treatment (RAI) for Graves’ Disease

Radioactive Iodine (RAI) treatment is the preferred treatment in the U.S. for Graves’ disease and its resulting hyperthyroidism. According to the New England Journal of Medicine, however, radioiodine therapy for Graves’ hyperthyroidism is more likely to apparently cause or worsen thyroid eye disease than is anti-thyroid drug therapy. This worsening can be temporary however, and may in some cases be prevented by use of the steroid prednisone.

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