EYE DISEASE (GRAVE'S DISEASE)
disease is the most common orbital disorder encountered in the eye doctor's
office. The orbit is the bony space which houses the eye and its supporting
structures. Grave's disease is an autoimmune disorder, meaning that
the immune system, in ways still poorly understood, interferes with
the normal function and structure of the orbit. It is frequently associated
with hyperthyroidism but has no definite relationship in either causation
or treatment with elevated thyroid hormone levels. Women are more commonly
effected by a ration of 4:1.
The usual age of onset is between 30 and 55.There is an entire
spectrum of signs and symptoms with Grave's disease.There are 6 classifications
Class Definition Features:
0 No signs or symptoms (Too subtle to notice)
1 Signs only; no symptoms Lid retraction
2 Soft tissue changes Swollen, dry, red eyes
3 Protruding eye ball Not always symmetrical
4 Eye muscle involvement Strain and double vision
5 Corneal involvement Ulceration and dryness
6 Vision Loss Optic nerve compression
The disease is self limiting, lasting between 1 and 5 years.
During all stages the disease should be managed by an eye doctor in
cooperation with a family doctor or endocrinologist, both of whom must
thoroughly understand this condition. Thyroid functions should be assessed
and controlled in the usual manner.Treatment of Grave's disease in the
early stages consists of treating the usual symptoms of dryness with
frequent artificial tears and lubricating ointments at night. If swelling
and redness are prominent, high doses of systemic prednisone have proven
very helpful. Sometimes radiation and immunosuppressive drugs are used.
If the eye protrudes, sewing the lids together prevents corneal exposure
and the serious complications of dryness. In extreme cases surgery may
be necessary to relieve the mounting orbital pressure. Permanent vision
loss may occur if this pressure is not relieved. If double vision persists
and is stable for at least 6 months,eye muscle surgery is very successful
at realigning the eyes.
We have much to offer patients with Grave's disease in
the way of medicines, surgery,and other supportive measures. Most patients
can return to a normal life with minimal limitations and imperfections.