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:
7. Intravenous immunoglobulins
Other treatment options include:
1. Radiation. This is similar to treating cancer by radiotherapy.