Graves’ ophthalmopathy, also known as thyroid eye disease, is an autoimmune inflammatory disorder of the orbit and periorbital tissues, characterized by upper eyelid retraction, lid lag, swelling, redness, conjunctivitis, and bulging eyes.
Several risk factors have been identified in the development of TED including genetics and family history, sex (women are at a higher risk than men), cigarette smoking, and treatment with radioactive iodine treatment.
Thyroid eye disease is a condition in which the eye muscles, eyelids, tear glands and fatty tissues behind the eye become inflamed. This can cause the eyes and eyelids to become red, swollen and uncomfortable and the eyes can be pushed forward ('staring' or 'bulging' eyes).
Some patients are left with permanent changes, and in others the eyes return to normal. A great deal can be done to improve these conditions with medical treatment, although some patients will need surgery to help ease their issues.
Early symptoms of thyroid eye disease are itching, watering or dry eyes and a feeling of grittiness of the eyes. Some people may notice a swelling around the eyelids and sometimes the front of the eye becomes swollen.
Anyone can get thyroid eye disease, but it's more likely if you have thyroid condition or Graves disease. If you notice that your vision is blurry, or that your eyes are often watery or dry or feel gritty, contact your health provider.
Living with TED can be both physically and emotionally challenging for people as their everyday lives are affected, from being unable to drive with double vision or sleeping with their eyes open. Some patients are unable to work due to visual changes or pain behind the eye.
There are two phases. The active phase, marked by inflammation, usually lasts from six months to two years. The focus during this stage is on medical treatment to relieve the eye symptoms. During the second phase, or the stable phase, inflammation and other symptoms have subsided.
Does It Cause Blindness? Most people only have mild symptoms. But around 3%-5% of those with thyroid eye disease have serious problems, which could include vision loss.
TED begins with an acute phase, which means that symptoms appear suddenly and often get worse. The acute phase can last from 6 months to 2 years. The inflammation (redness and swelling) and scarring that start to form during this phase can damage your eyes, and cause a number of changes.
Thyroid hormones also influence the quality of your skin in various ways. For example, with hyperthyroidism, you may notice itchy and dry patches of skin. Your face may feel softer and swollen. You may even notice swelling around your fingertips.
To diagnose thyroid eye disease, you will need a complete eye exam, lab tests, and imaging tests. The ophthalmologist will test your vision, color vision, and visual fields. In addition, eyelid measurements will be taken, eye pressure tested, and optic nerve checked.
Thyroid eye disease (TED) is an autoimmune disease caused by the activation of orbital fibroblasts by autoantibodies directed against thyroid receptors. TED is a rare disease, which had an incidence rate of approximately 19 in 100,000 people per year in one study.
Thyroid eye disease is most commonly associated with Graves' disease. It can also occur with normal thyroid hormone levels or low levels of thyroid hormones (hypothyroidism). Other risk factors for thyroid eye disease include: Age: Usually affects middle-age adults but can occur at any age.
A swollen fingertip, curved nail, and thickening skin above a nail are often signs of thyroid disease.
Total thyroidectomy prevents further progression of Graves' eye disease and is an immediate cure of the process. For this reason, surgery is the preferred treatment for patients with Graves' eye disease.
People with hypothyroidism may also have headaches, including pulsing pain, on both sides of the head. In most cases, the headaches subside after the person receives effective treatment for hypothyroidism.
The most common sign of TED is upper eyelid retraction, unilateral or bilateral, that occurs in over 90% of patients12,13 (Figure 1). The resultant wide-eyed appearance allows for chronic eye exposure, especially during sleep.
There is growing evidence of thyroid eye disease association with nutritional deficiencies including selenium and vitamin D.
Over time the thyroid usually returns to its normal state. Because the stored thyroid hormone has been released, patients may become hypothyroid (where their thyroid gland produces too little thyroid hormone) for a period of time until the thyroid gland can build up new stores of thyroid hormone.