Graves’ eye disease, often called Graves’ orbitopathy or exophthalmos, occurs in approximately 40% of patients who have Graves’ disease. There is no good evidence that treatment of Graves’ disease with antithyroid medication leads to any improvement in Graves’ eye disease! It has been noted that oftentimes hypothyroidism which can be induced by antithyroid medications can worsen orbitopathy. Recently, there are two large random controlled trials that showed de novo development of Graves’ orbitopathy or worsening in approximately 15% of patients who had already undergone radioactive iodine therapy.
Grave’s Disease Can Cause Blurry Vision, Bulging Eyes & Even Blindness!
The reason that the eyes tend to bulge in Graves’ disease is because of deposition in the eye muscles that control the eyes. The eye is contained in a bony cone that can be thought of like an ice cream cone. Deposition into the cone portion causes the eyeball (the ice cream portion) to bulge out of the cone. The more deposition that occurs within the cone, the more bulging occurs. The real risk in Graves’ orbitopathy is not just in the cosmetic appearance, but the potential for stretching of the optic nerve. This stretching of the optic nerve can even lead to blindness in severe cases. In addition to optic nerve effects, the deposition in the bony orbit can cause restriction of muscle movement – resulting in blurred vision or pain when the eye moves toward the middle of the face. Some of these visual changes can be improved with steroid therapy, however, the disease tends to progress as soon as steroid therapy is stopped.
Treating & Preventing Eye Disease in Graves
Long-term steroid therapy is not safe or recommended for controlling Graves’ eye disease. The only option that will definitively stop the Graves’ orbitopathy and keep it from progressing is surgical removal of the thyroid gland. This can be done very safely in the hands of a high-volume, experienced thyroid surgeon. While we know that Graves’ disease operations have a higher complication rate, this can be minimized by seeking treatment with a high-volume surgeon. Frequently, orbital disease is improved simply by surgical intervention and removal of the thyroid gland. If the eye disease has made more permanent changes, there are some specific operations which can be done to correct the orbitopathy.