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It starts out like an allergy, with red, irritated eyes. Graves ophthalmopathy, also called thyroid eye disease, affects about half the patients with Graves hyperthyroidism. Marty Feldman's “Igor” character in Young Frankenstein had the characteristic symptom of exophthalmus, which means the eyes appear to bulge out of the face. Other symptoms include irritation with redness and tearing, lid retraction, swelling of the tissue around the eyes, double vision caused by restricted eye mobility, eyelid edema (swelling from excess fluid), pain, light sensitivity, exposure keratopathy, and optic neuropathy.
There is a wide variety of treatment options, ranging from eye drops and sunglasses up to surgery to remove part of the bone around the eyes. A review article from the medical literature reports that treatment decisions should be based on both the severity and the activity of the disease. Many cases will clear up spontaneously, and you may not want invasive eye surgery for something that lasts only a few months. On the other hand, the orbital decompression surgery is very effective for patients who have a severe case that does not clear up or respond to other treatment.
Conservative treatment for mild cases includes the following:
1. Sunglasses for light sensitivity. These may also be useful for cosmetic reasons.
2. Artificial tears and ointments for eye irritation and the feeling that something is in the eye.
3. Beta-blocking eye drops for eyelid retraction or increased intraocular pressure.
4. Nocturnal taping of the eyes in cases where the eyelids do not completely close during sleep.
5. Prism glasses for double vision.
6. Treatment of the primary thyroid problem, including the elimination of risk factors such as smoking.
For more severe cases, drug treatment may be beneficial. Glucocorticoid steroids are the standard, but many others have been used:
1. Cyclosporine
2. Octreotide
3. Lanreotide
4. Cyclophosphamide
5. Bromocriptine
6. Metrodinazole
7. Intravenous immunoglobulins
8. Rituximab.
Other treatment options include:
1. Radiation. This is similar to treating cancer by radiotherapy.
2. Plasmapheresis. This is a procedure to filter autoantibodies from the blood, and is used for several autoimmune conditions. For thyroid eye disease, it is regarded as a “desperate” treatment when drugs have failed.
3. Orbital decompression surgery. Part of the bone around the eye is removed to provide more room for the swollen tissues in the eye orbit.
4. Extraocular muscle surgery and eyelid surgery. These are considered rehabilitative procedures to improve the cosmetic appearance of the eye and the ability to move both eyes normally to correct double vision.
There are 14 clinical trials currently in progress for this condition. Check with your doctor if you're interested in participating.
Sources:
Photo of patient with Graves Ophthalmopathy:
http://discoverysedge.mayo.edu/de08-4-endo-bahn/index.cfm
Kuriyan AE at al, “The eye and thyroid disease”, Curr Opin Ophthalmol. 2008 November; 19(6): 499-506.
Bartalena L et al, “Management of Graves' opthalmopathy: Reality and perspectives”, Endocrine Reviews 2000; 21(2): 168-199.
Clinical trials:
http://clinicaltrials.gov/ct2/results?term=graves+ophthalmopathy
Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.
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