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THYROID EYE DISEASE (GRAVE'S DISEASE)

  Grave's 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 of involvement:
  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.

© nholland 2002