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Diagnosis and treatment of thyroid eye disease

Graves' disease is an autoimmune disease most commonly affecting the thyroid. It can also
affect the eyes, causing bulging eyes (proptosis) and other systems of the body, including the
skin, heart, circulation and nervous system. It occurs more commonly in female population,
often starting when patients are in there 30’s and 40’s. Smoking and exposure to second-hand
smoke has been shown to worsen eye disease. Diagnosis is usually made on the basis of
symptoms, although thyroid hormone tests may be useful, particularly to monitor treatment.

Graves' disease may present clinically with one of the following characteristic signs:

  • proptosis (protuberance of one or both eyes)
  • fatigue, weight loss with increased appetite, and other symptoms of hyperthyroidism
  • rapid heart beats
  • muscular weakness

  • Thyroid-associated ophthalmopathy is one of the most typical symptoms of Graves' disease.
    Thyroid eye disease is an inflammatory condition, which affects the orbital contents including
    the extraocular muscles and orbital fat. Most common sign is upper eyelid retraction, making
    one eye appear bigger/more open than the other. The ocular manifestations that are relatively
    specific to Graves' disease include soft tissue inflammation causing proptosis (protrusion of one
    or both globes of the eyes), double vision, corneal exposure, and optic nerve compression.


  • Mild cases are treated with lubricant eye drops. Severe cases threatening vision (Corneal
    exposure or Optic Nerve compression) are treated non-surgically with oral or IV steroids
    and surgically with orbital decompression. In all cases cessation of smoking is essential.
    Double vision can be corrected with prism glasses and surgery (the latter only when the
    process has been stable for at least 6 months).
  • Difficulty closing eyes can be treated with lubricant gel at night.
  • Orbital decompression can be performed to enable bulging eyes to retreat back into eye
    sockets. Bones of the orbit are thinned behind the eyeball to create more space for the
    muscles and fatty tissue to fall back into its more natural position.
  • Eyelid surgery can be performed on upper and/or lower eyelids to reverse the effects of
    Graves' on the eyelids. Upper eyelid retraction is repaired by weakening the muscle that
    is responsible for eye being more open and exposed to air. It helps reduce or eliminate
    dry eye symptoms.
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