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Hyperthyroidism

Hyperthyroid Eye Disease

Last updated on:
21/04/2013

Contributing Author: Guy Slowik FRCS

Graves' disease may be associated with particular eye changes.

The eye changes are called hyperthyroid eye disease and occur in about 30 percent of people with Graves' disease. These changes are visible as protruding eyes. There is no relationship between the appearance of eye changes and the severity of the hyperthyroidism. There is increased risk for infection and visual problems in persons with severe hyperthyroid eye disease.

Eye disease is most likely to progress in people who fit a certain profile. This includes those:

  • Whose hyperthyroidism is not promptly corrected and controlled
  • Whose thyroid hormone level is not within normal limits
  • Who smoke cigarettes

The autoimmune process that causes hyperthyroid eye disease is poorly understood. Doctors do understand that there is swelling of tissues behind the eyeball, decreased range of motion of the muscles around the eyeball, and retraction (a pulling back) of the eyelids.

Common symptoms include pain, excessive tearing, increased sensitivity to light, blurred vision, double vision, or protrusion of the eyes from the face.

Most people with hyperthyroid eye disease do not need any treatment beyond special eye drops. When more extensive care is required, treatments may be needed to decrease the pressure on the eyeball. This increase in pressure is the result of tissue swelling in the eye sockets. Additional treatment may be required to increase the range of motion (ROM) of the eyes or to improve the cosmetic appearance of bulging eyes. These may include:

  • Treatment with certain drugs such as steroids or immunosuppressive drugs to decrease the swelling behind the eyes.
  • External radiation therapy to decrease swelling behind the eyes.
  • Surgery to remove a small portion of bone from the eye socket.
  • Treatment with certain medications such as steroids or immunosuppressive drugs to help improve eye muscle function and increase range of eye muscle movements.
  • Plastic surgery to improve the appearance of eyes or eyelids

How-To Information:

When discussing treatment options, it is important to discuss several issues with your ophthalmologist including:

  • Your chief concern about your eyes
  • How will this concern be treated
  • The chief medical concern from the eye doctor's perspective
  • How will treatment address his or her concerns
  • The presence of additional, significant medical conditions
  • How the proposed treatment plan affects these pre-existing conditions
  • The timing of treatment steps and the particular order of these possible treatments. For instance, it may be advisable to correct abnormally high or low levels of thyroid hormone before beginning additional treatment.

 

 
 
 

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From Andrew Maynard - Chair of the University of Michigan Department of Environmental Health Sciences, with help from David Faulkner - 2013 Master of Public Health graduate.