Graves' Ophthalmopathy - How Does It Affect Your Eyes?

One of the more serious conditions that can impact the eyes is Graves' ophthalmopathy. How and to what degree can it affect your vision and what can you do about it? We will take a look at some basic information about it in this article.

What is Graves' ophthalmopathy?

Graves' ophthalmopathy, also known as thyroid eye disease, is an autoimmune condition. This means that the person's immune system, in charge of protecting the body from virus and bacteria, mistakenly attacks and damages the healthy tissues of the body instead.

The way the eye is affected is that those antibodies eventually attack the fat cells, tissues and muscles behind the eye. As they get damaged, they become inflamed, compressing veins that drain fluid from the eye and, in severe cases, the optic nerve, affecting sight significantly.

Two phases have been identified in Graves' ophthalmopathy: active and inactive. 

During the active phase it is possible to experience eye irritation, loss of visual acuity and changes in the appearance of the eye. This phase can last from around 5 months up to a few years and it's followed by an inactive phase in which the condition stops progressing but some symptoms remain. If Graves' ophthalmopathy is left untreated it can lead to serious loss of sight and even blindness. 

What are the symptoms of Graves' ophthalmopathy?

Graves' ophthalmopathy can be difficult to detect at first, but there are a number of symptoms that can indicate you have this condition. These could be:

  • Eyelid retraction, with upper eyelid retraction being the most common symptom. It might also feel painful to close the eye.
  • Eye redness and irritation.
  • Feeling of pressure in the eye and difficulty to move the eyeballs.
  • Bulging of the eyes.
  • Blurry vision.
  • Double vision.
  • Overly dry or overly watery eyes.
  • Higher sensitivity to light.
  • Vision loss; this can be caused by the compression of the optic nerve as the eye and the tissue and muscles around it become inflamed or by damage in the cornea, which becomes more exposed and doesn't receive proper lubrication.

What are the risk factors for developing Graves' ophthalmopathy?

  • Genetics: Graves' ophthalmopathy can be of genetic origin, as there are a few genes that were confirmed to be the cause in people with the disease. Women are also much more likely to have this condition than men.
  • Other conditions: People who suffer from immune disease can be prone to develop this condition. Graves' disease, for example, can be a factor, however having it does not mean you will have Graves' ophthalmopathy or vice-versa. Patients can have one of them, both or neither.
  • Environment: It is speculated that environmental factors can also influence the risk of developing this condition. Drinking alcohol and smoking are generally accepted as habits to avoid, since they increase the risk to develop various conditions.
  • Age: It can also be considered a risk factor, as the condition tends to appear more frequently in middle aged people.

How do you treat Graves’ ophthalmopathy?

In some cases, Graves' ophthalmopathy gets better on its own, but most people will require treatment. Depending on the level of progression and the damage caused by this condition there are various approaches to fight it.

  • Active Stage

During the active stage of the disease your ophthalmologist might prescribe corticosteroids to help reduce the inflammation, as well as eye drops or ointments to relieve dryness and irritation of the eye.

In January 2020 the U.S. Food and Drug Administration (FDA) approved the use of teprotumumab to treat Graves' ophthalmopathy, becoming the first drug approved  to treat this condition. It's impact has been very positive in reducing eye inflammation and double vision and in improving patients' quality of life.

Radiotherapy is sometimes also recommended to reduce inflammation of the eye. It works by eliminating damaged tissue, although its effectiveness has not been widely proved.

  • Inactive Stage

Once the condition stops progressing and goes into its inactive stage, surgery might be recommended. Some procedures could be:

  • Eyelid surgery: As the eyelid retracts, the normal appearance of the eye changes and the eye's surface becomes more exposed. Diverse kinds of eyelid surgery can correct this, usually by lengthening the eyelid until it regains its normal shape.
  • Orbital decompression: Depending on the severity of the condition, pressure could have built in the tissues behind the eye, contributing to eye displacement and hindering vision if the optic nerve has become compressed. This procedure involves the removal of some bone from the eye socket to accommodate the eyeball and the inflamed tissue. This allows the eye to return to a natural position and reduces the compression of the optic nerve.
  • At any stage

Since Graves' ophthalmopathy can cause important changes in the vision and in the appearance of the eyes that can't be fully corrected, patients might experience depression and emotional distress. Receiving therapy and having support from their loved ones might be beneficial to help them cope with the psychological impact of this condition.

Wearing filter sunglasses with UV protection can be helpful to reduce glare and cope with the heightened sensitivity to light caused by Graves' ophthalmopathy.

Also, you can read our article for more helpful tips on how to keep your eyes from getting dry.

In Conclusion

Graves' ophthalmopathy can be a severely damaging condition, so being mindful of any signs that you might be developing it and having regular eye examinations with your ophthalmologist are essential to detect it and treat it effectively.