Graves' Disease Eye Symptoms and Images - Bulging, Dry Eyes

What Does Graves' Disease Do to Your Eyes? Images and Symptoms of Thyroid Eye Disease

Graves' disease is an autoimmune disorder that leads to hyperthyroidism or an overactive thyroid. In some cases, it can also cause thyroid eye disease (TED), which affects the muscles and tissues around the eyes.

Thyroid eye disease is also referred to as Graves' ophthalmopathy or orbitopathy. Up to 50% of people with Graves' disease will develop some degree of TED, which can cause various eye problems and changes in appearance.

What Causes Thyroid Eye Disease?

The exact cause is unknown, but it's believed TED is related to autoimmunity and a shared antigen between the thyroid and tissues around the eyes. This leads to inflammation and an immune system attack on the ocular muscles and fat in the orbits.

Signs and Symptoms of Graves' Disease Eye Problems

The signs and symptoms of thyroid eye disease may include:

• Eye bulging (proptosis)
• Retraction or lack of motion in eyelids
• Double vision (diplopia)
• Dry, gritty, irritated eyes
• Light sensitivity or photophobia
• Red or swollen eyes
• Pressure or tightness behind the eyes
• Eye pain, tenderness, or ache

What Does Eye Bulging Look Like in Graves' Disease?

One of the most common TED symptoms is proptosis or eye bulging, which creates a wide-eyed stare. With Graves' disease, inflammation puts pressure on the tissue and muscles surrounding the eyes.

This can push the eyeballs forward, making them appear to bulge out. Mild proptosis may be noticeable in photos but not sempre evident looking straight at someone. More pronounced proptosis can cause a startled, bug-eyed look.

Graves' Disease Eye Bulging Pictures

Image source: Getty Images

This photo illustrates how Graves' disease can make eyes appear to bulge or protrude outward.

Image source: IMAGESARTICLEWEBSITE.COM

A closer view of proptosis of the eyes caused by thyroid eye disease and inflammation of the orbital tissues.

What About Eye Retraction?

While eye bulging is more common, some people with Graves' disease can experience the opposite - eye retraction. Limited or impaired eye muscle movement can cause the eyes to appear sunken or retracted into the orbits.

Eyelids may also not open fully, giving the eyes a hooded, heavy-lidded look. Eye retraction occurs when scar tissue limits normal muscle movement. Damage to the eye muscles can cause the eyes to be pulled back into the sockets.

Double Vision (Diplopia)

Many Graves' disease patients experience diplopia or double vision. This happens when the eyes aren't properly aligned due to inflammation and impaired eye muscle control.

The eyes may be pointing in different directions at the same time, causing two overlapping images. Double vision can come and go, happen intermittently, or be constant.

Dry, Irritated Eyes

Thyroid eye disease can reduce tear production, leading to chronically dry eyes. This uncomfortable condition is called dry eye syndrome or keratoconjunctivitis sicca (KCS).

Inflammation can also cause the surface of the eyes to become irritated. People describe feeling like they have sand in their eyes. Photophobia or light sensitivity often accompanies dry, gritty eyes.

Red, Swollen Eyes

The autoimmune attack on eye tissues leads to inflammation, redness, and swelling. Graves' disease can cause eyes to look swollen, pink or bloodshot.

The delicate eyelid tissue can become inflamed and puffy as well. Increased pressure behind the eyes leads to a feeling of tightness. Mild throbbing or aching may be present too.

When Do Graves' Disease Eye Problems Occur?

For those who develop TED, symptoms most often appear within 18 months of thyroid dysfunction and hyperthyroid diagnosis. However, eye disease can occur months to years before or after a Graves' diagnosis.

Eye changes happen rapidly at first then progress more slowly. Symptoms typically peak within 3-4 years before gradually resolving over the next few years.

Mild, Moderate and Severe Cases

Thyroid eye disease occurs on a spectrum from mild to extremely severe. Symptoms range from minor irritation and eyelid swelling to major proptosis, vision loss and corneal ulceration.

Mild TED - Subtle eyelid swelling, mild dryness or irritation, some eye prominence, and occasional double vision.

Moderate TED - Noticeable proptosis, more constant diplopia, moderate inflammation and eye redness, photophobia and dryness.

Severe TED - Significant proptosis (over 25mm), severe bulging causing lagophthalmos or inability to close eyelids fully. Severe constant diplopia, eye pain, vision loss risk.

Diagnosing Graves' Ophthalmopathy

An ophthalmologist will examine your eyes to check for signs of thyroid eye disease if you have Graves' disease. Tests may include:

• Vision checks
• Eye prominence and motility measurements
• Imaging like CT or MRI scans
• Tear production measurement
• Eye pressure test

Your doctor will grade the severity of inflammation and symptoms to guide treatment. Getting prompt treatment can help prevent permanent eye damage from thyroid eye disease.

Graves' Disease Eye Treatment Options

Treatment focuses on managing symptoms and minimizing further damage until TED runs its course:

• Lubricating eye drops - For dryness and irritation.
• Anti-inflammatory medication - Steroids help reduce swelling and inflammation.
• Prisms or patches - For temporary double vision relief.
• Eyelid surgery - Can help close gaping eyes unable to fully close.
• Orbital decompression - Surgery can create space to allow proptosis to recede.
• Eye muscle surgery - Adjusts eye position and alignment.

The most severe cases may require surgical intervention to prevent vision loss and corneal damage. Prompt thyroid hormone treatment can also minimize thyroid eye disease progression.

What Is the Prognosis for Graves' Eye Disease?

The course of TED varies, but typically reaches maximum severity within 3-4 years before slowly improving. Symptoms eventually resolve in many patients over time.

With proper treatment, the outlook is good for managing symptoms. However, some patients are left with residual effects like limited eye movement, diplopia, proptosis, or dry eyes.

Rarely, TED can cause severe vision loss when eye exposure damages the cornea. Vision-threatening cases require urgent treatment.

Preventing Thyroid Eye Disease Complications

You can help reduce the risk of permanent eye

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.