Graves' disease is an autoimmune disease in which white blood cells attack the thyroid gland and cause the gland to release more thyroid hormone. Graves' eye disease--also known as Graves' ophthalmopathy--occurs when these white cells attack the tissues around the eye, causing inflammation and swelling. Some symptoms of Graves' eye disease may cause discomfort or irritation, and others may be severe enough to cause vision loss. The symptoms of Graves' eye disease may improve as the Graves' disease itself is being treated, but in other cases, medical or surgical treatments may be required.
Eyelid Retraction
The most common symptom of Graves' eye disease is the retraction of the upper and lower lids. In retraction, the eyelids don't fully close to cover the eyeball, which can lead to problems with the cornea. If this condition doesn't improve over time it can be treated by medications or surgery to enable the eyelids to close.
Proptosis
Graves disease causes inflammation of the tissues around the eye and inside the eye socket, which in turn causes the eyeball to be pushed forward. This is called proptosis and can also cause problems with the cornea of the eye. This condition can be treated with medications or surgery in which a wall of the eye socket is removed to allow room for the swollen tissues.
Dry Eye Symptoms
The exposure of the cornea that is caused by the combined problems of eyelid retraction and proptosis can make the eye feel gritty and dry. In turn, the dry eye symptoms cause the eye to tear and become red from the irritation. Using lubricants, such as artificial tears and ointments, can improve the symptoms for many patients.
Double Vision
In Graves' disease, the muscles around the eyes are inflamed and swollen. The inflammation in these muscles can make it difficult to move the eye in any direction, which can lead to double vision because the eyes don't move in unison any more. Medications, such as steroids, can treat the inflammation, or the muscles of the eye can be realigned with surgery once the condition has stabilized.
Optic Nerve Compression
Because all of the tissues around the eye are swollen in people with Graves' disease, the optic nerve can be compressed or squeezed. This can cause damage to the optic nerve by killing nerve cells, and it may also cause long term vision loss. Eye doctors may use medications or surgery to relieve the pressure on the optic nerve.
