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Save Your Vision from Graves’ Ophthalmopathy

Sight is considered one of our primary senses and is made possible with our eyes. Because the eyes are such a delicate piece of our system it is important that they receive proper attention and care. March is designated as Save Your Vision Month which provides an opportunity to discuss eye health. Maintaining proper eye health is usually not a challenge for individuals. However, there are numerous conditions that impact the eye. Some of these can severely damage the eye causing great discomfort and even loss of sight. One such condition is Graves’ Disease, or more specifically, Graves’ ophthalmopathy.

Graves’ Disease Basics

Although Graves’ Disease is the most common cause of hyperthyroidism, the condition itself falls into the category of autoimmune disorders. It is estimated that the immune malfunction affects nearly 10 million individuals. The reason it belongs in this caste of illness is because it attacks one’s own body. In the case of Grave’s Disease, the thyroid gland suffers a great deal from the self-inflicted damage. This induces an excessive release of thyroid hormone which can cause one’s metabolism to spike upwards, which negatively impacts various systems and tissues throughout the body.

Those in this group may experience an array of symptoms including:

  • Fatigue
  • Weight loss
  • Rapid and/or irregular heartbeat
  • Fluctuations in sex drive
  • Muscle weakness
  • Heat intolerance
  • Increased perspiration
  • Mood changes such as irritability, nervousness and anxiety
  • Increased appetite
  • Reduced menstruation
  • Insomnia
  • Eye irritation
  • Blurred and/or double vision
  • Bulging eyes

When someone with Graves’ Disease suffers from symptoms involving the eyes, it is likely they are experiencing Graves’ ophthalmopathy.

Graves’ Ophthalmopathy

Malfunctioning TSH receptors and immune cells within the eyes are major contributors to Graves’ ophthalmopathy. Interestingly, ophthalmopathy is not directly correlated to thyroid function but it is greatly associated with Graves’ Disease itself. Fortunately, only about 5% of those suffering from this disease experience extreme ophthalmopathy.

It is common for those with Graves’ Disease to experience some sort of eye discomfort. Usually this is caused by pressure being placed on the eye itself due to inflamed or expanding tissues. Because there is little space within the orbit of the eye, swelling can cause serious issues.

Inflammation due to Graves’ ophthalmopathy can last anywhere from a few months to a few years. Inflammation can be focused in various regions of the eye, which can cause pressure and leave the eyelids puffy. One may also experience inflammation in the lacrimal glands which can cause alternating excessively wet or dry eyes.

Bulging eyeballs, also known as exophthalmos or proptosis is a distinguishing feature of Graves’ ophthalmopathy. In severe cases, the eyes can be pushed to such a degree that one’s eyelids don’t close properly. This leaves the eyes unprotected, allowing the cornea to become dry and exposed to other dangers. Furthermore, if swelling is sustained and intense, permanent damage can be done to the tissues leaving them stretched. Excessively strained eye tissues can cause one’s eyes to remain protruding. Eyes in this state can inhibit blinking, cause irritation, and reduce visual ability.

Grave’s ophthalmopathy can also cause swelling within the orbit that can cause eye muscles to weaken thereby inhibiting eye movement and reducing peripheral vision. One’s ability to perceive color may be impacted as well due to intense swelling around the eye. In extreme cases, pressure can cause the optic nerve, which connects the eye to the brain, to become compressed. If left unattended for too long, damage may become irreversible.

Thyroid Related Eye Disease

Even though one may not have Graves’ ophthalmopathy proper, they may experience thyroid related eye disease due to a malfunctioning autoimmune system. Those with a thyroid condition, caused by Graves’ Disease or otherwise, can experience fluctuating degrees of wellness regarding their eyes. Even though one may go through long periods of remission, eye disease can flare up again. However, if one does not experience significant eye-related symptoms for 6 months, the risk of recurring disease is reduced. One can recognize thyroid-related eye disease, including Graves’ ophthalmopathy, from the following symptoms:

  • Pain in and around the eyes
  • Eye irritation such as itchiness, redness, and dryness
  • Tissue swelling and inflammation in and around the eye
  • Exophthalmos or proptosis (bulging eyes)
  • Diplopia or double vision
  • Inhibited visual capacity
  • Sensitivity to light
  • Difficulty moving one’s eyes

Putting Grave’s Ophthalmopathy to Rest

Most doctors can quickly identify Graves’ ophthalmopathy through a simple eye exam if it is known that the patient has an existing thyroid condition. Even without this knowledge, they may have blood tests done to test for possible thyroid dysfunction. However, testing is not always reliable. Some develop euthyroid Graves’ Disease which presents normal thyroid levels and activity while inducing symptoms associated with thyroid disease. If one believes they may be suffering from Graves’ ophthalmopathy, it is important that they pursue thorough analysis and testing.

Most treatments for Graves’ ophthalmopathy include application of lubricants to the affected area, which is often in and around the eye. Severe cases, particularly those who are at risk of optic nerve damage, may require specialized treatment. Resolving pressure caused by inflamed tissue may require one to undergo orbital decompression surgery. This procedure involves removing thin bones within the orbit to create extra space. The goal of the operation is to improve eye movement and relieve pressure in the orbit. This procedure may also reduce the risk of glaucoma and further decrease tissue inflammation.

Keep Your Eyes on the Prize

Being well informed about Graves’ Disease and its eye-threatening implications can help prevent loss of vision. Recognizing the signs and symptoms of Graves’ ophthalmopathy early is highly beneficial in getting proper treatment to keep your eyes healthy. Caring for one’s eyesight positively impacts daily life and can help prevent the debilitating impact of losing one’s vision. Because March is Save Your Vision Month it is a good time to become educated on eye disease and take preventative measures against it. Hopefully, having some light shed on vision inhibiting conditions will keep you out of the dark and promote greater eye wellness.

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Important to note that simple hyperthyroidism, as well as Hashimotos can produce eye issues as well. Awesome article!

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