Graves’ disease is a thyroid disorder in which the thyroid gland, which produces hormones in response to an infection caused by viruses or bacteria, is overactive, causing a number of physical reactions, including weight loss, rapid heart rate, sweating, and changes to bone, skin, and nails. The eyes are affected through a separate, yet related disease called Graves’ Ophthalmopathy. In Graves’ Ophthalmopathy, the overactive thyroid targets the area surrounding eyes and may cause inflammation, redness, achiness, pink eye, eyelid retraction and bulging eyes.

Although Graves’ Ophthalmopathy is caused by a hyperactive thyroid, the hormones that affect the eyes are not the same ones that cause reactions in other parts of the body. In roughly 10% of cases, people with Graves’ Ophthalmopathy do not actually have Graves’ disease.

In extreme cases of Graves’ Ophthalmopathy, swollen eye muscles may put extreme pressure on the optic nerve, leading to double vision, or vision loss.

What Causes Graves’ Ophthalmopathy?

In Graves' ophthalmopathy, inflammation and other immune system events affect muscles and other tissues around the eyes. 

Symptoms of Graves’ Ophthalmopathy

An eye care professional can determine the presence of Graves’ Ophthalmopathy through a thyroid function test after observing common symptoms.

The most common symptoms of Graves’ Ophthalmopathy are associated with inflammation, swelling and redness of the eyes. Symptoms vary from patient to patient and can include:

  • Eye inflammation

  • Eye redness

  • Bulging eyes

  • Eye dryness

  • Eye weakness

  • Eye sensitivity

  • Eyelid retraction

Treatment for Graves’ Ophthalmopathy

Symptoms of Graves’ Ophthalmopathy may clear without intervention within a year. Many patients will need to continue treatment to regulate the overactive thyroid, and continue with symptom-based treatments. 

Overactive thyroid treatments may include:

  • Radioiodine therapy: a treatment in which radioiodine is ingested to kill overactive thyroid cells

  • Anti-thyroid medications: used to treat the symptoms of an overactive thyroid, as well as to slow or stop the production of antibodies

  • Thyroid surgery: used for the removal of the overactive thyroid gland, accompanied by hormone replacement therapy

Symptom-based treatments:

  • Medications: includes topical lubrications such as artificial tears, and other treatments to relieve eye inflammation and lubricate bulging eyes

  • Surgery: surgical options are available for several symptoms of Graves’ Ophthalmopathy, including procedures to remove portions of the orbital region to make room for swollen tissue, realign weakened eyes to prevent double vision, and relieve discomfort and appearance issues associated with retracted eyelids.