Graves eye disease is an inflammatory condition of an eye due to the autoimmune response of the body’s immune system for the thyroid gland. The thyroid gland is placed in front of the neck in the middle of the trachea. The thyroid gland produces thyroxin ( T3 & T4) which increases the metabolism and other body functions. When the thyroid produces less amount of thyroxin, it is termed as Hypothyroidism. Whereas, when thyroxin produces in excess amount, it is known as hyperthyroidism or thyrotoxicosis. Graves eye disease or other thyroid eye diseases are caused by hyperthyroidism.

In autoimmune disease, the body’s immune system becomes activated and starts damaging the eye or thyroid gland. The patient has a toxic look and proptosis. Eyelids are retracted and cause dryness of eye which can lead to corneal ulceration. In severe disease, eye muscles inflamed and limited the eyeball movements. Eye movements become painful and cannot move. Rarely, it puts pressure on the optic nerve and may cause blindness.

Causes of Graves Eye Disease

Graves eye disease is an autoimmune disease in which auto-antibodies are formed against the thyroid gland, these antibodies resemble with the receptors over the thyroid follicles and activate the thyroxin production. This thyroxin production becomes continue and the patient presents with the palpitations, fast heartbeat, rapid pulse, high blood pressure, headache, or profuse sweating. Up to half of the grave’s patients have developed the eye symptoms which can be treated.

Eye symptoms appeared because of the inflammation of soft tissues and muscles of the eye. Swelling and fat deposits under the eye. This swelling causes the eye to pushed forward and bulged, causing Grave’s Eye and the patient has toxic look, limited eye movements, and painful eye movements.

Symptoms of Graves Eye Disease

When thyroid activity becomes uncontrolled, some symptoms appeared early, if not treated, they become more aggressive. They are

Early Symptoms

Irritation in the eye, excessive tear production, double vision, swelling and redness of the eye, forward displacement of the eye

Late Symptoms

Painful eye movements, limited eye movements, corneal ulceration, rarely loss of vision

Investigations and Diagnosis

Following investigations are done to diagnose the disease.

1- Thyroid Function tests

To measure the serum TSH, T3, and T4 level

2- Imaging

Ultrasound, CT scan, or MRI are done to localized the deceased part of the thyroid gland.

3- Thyroid scan

By radioactive elements, to check the function of the thyroid gland.

4- biopsy

Tissue extraction is done to check the tumor marker or any malignant condition.

5- Eye Checkup

Refer the patient to an ophthalmologist to have the proper eye examination.

TREATMENT OPTIONS FOR GRAVES EYE DISEASE

1- General Measures

Ask the patient to take iodine-free salt. Wear sunglasses or shades to protect the eye from solar ultraviolet radiation. Use cold or warm compresses to have relief. You may also use artificial tears. People having graves eye disease are often advised to sleep with their elevated head to reduce the swelling. If you are facing double vision, glasses with prims can be used as well.

Bath sponges are done to control body temperature. Have proper eye checkups regularly to prevent the progression of the latent eye disease. Also carefully monitor the blood T4 & T3 level to prevent the sudden rise or fall in thyroxin level.

2- Medication

To control the thyroxin level, anti-thyroid drugs are prescribed. Selenium supplements are advised to the patients for six to eight months, it reduces the swelling and mild symptoms. Corticosteroids are infused I/V In graves eye disease to control the inflammation.

3- Chemotherapy or Radiotherapy

The best way for uncontrolled toxic conditions, chemotherapy, or Radiotherapy is done to control thyroid production.

4- Surgery

Eyelids are surgically corrected to reduce the swelling or puffiness. Sometimes, the thyroid gland is surgically removed.

Prognosis

Prognosis of the graves eye diseases is good. It can be treated successfully with mild symptoms.