Graves' disease and the associated eye changes (thyroid related eye disease - TED) can be frustrating for affected patients. The eye symptoms usually occur around the the same time as the onset of the thyroid dysfunction.  Many patients with thyroid abnormalities will only be affected mildly by the eye disease.  Approximately 5% of the patients with TED will have severe disease that can cause vision loss and blindness.  Although the incidence of eye disease associated with thyroid dysfunction is higher and more severe in smokers, there is no way to predict which patients will be affected.  In many cases successful treatment of the thyroid gland does not guarantee that the eye disease will improve no thyroid treatment can guarantee that the eyes will not continue to deteriorate. Once inflamed, the eye disease may remain active from several months to as long as three years.  In some cases there may be a gradual mild improvement.

Medical Treatment

Early eye symptoms, which may include dryness, redness, itching, swelling of the lids and inability to wear contact lenses, are usually mild. Some patients find these symptoms to be particularly irritating at night and under certain conditions such as air conditioning, hot air heating and windy days. A few patients will develop double vision (diplopia), which is the result of asymmetric scarring and inflammation of the muscles that control eye movement. Many patients are often misdiagnosed with an ocular allergy and should be examined and followed by an Oculoplastic/Orbit specialist familiar with the condition and available treatments.  There are many treatments available to treat the annoying discomfort caused by TED.  These treatments can be custom tailored to your condition by your specialist.

Vision loss due to pressure on the optic nerve is the most severe form of the disease. This condition affects approximately 5% of patients with TED.  Vision loss is often not detectable by the patient without special testing and examination.  If detected in the early, further vision loss can be prevented with prompt treatment.  Once damage has been done to the optic nerve, recovery of the area of lost vision is not likely, making it imperative that vision loss is discovered and treated as quickly as possible.

Surgical Management

If the eye condition does not improve or deteriorates then surgery may be required. Retracted and puffy eyelids can alter a person's appearance and increase the risk of cornea drying. Corrective eyelid surgery can alleviate the problem through adjustable loosening of the eyelid muscles, as well as removal of scar tissue, excessive fatty tissue and skin to place the eyelids into a more normal position. Surgery may also be necessary to correct double vision. The enlargement of tissue behind the eye may sometimes cause significant forward protrusion of the eye (exophthalmos), which produces the characteristic appearance, worsens the symptoms, and causes ocular exposure. There are surgical procedures to decrease the amount of exophthalmos.  This procedure is called an orbital decompression.  Orbital decompression is also used to treat patients with significant exophthalmos, visual loss, or severe exposure of the corneas.

If you have more questions or concerns about your thyroid eye disease, find an experienced oculoplastic/orbital specialist to help guide your choices in treatment.