Autoimmune condition associated with Grave’s disease seen in 25-50% of people with Graves’.
Due to a specific immune response that causes retro-orbital inflammation. Swelling and oedema of the extraocular muscles lead to limitation of movement and to proptosis which is usually bilateral
Causes/Factors
- Main known risk factor is smoking
- Eye disease may not correlate with thyroid disease - patient can be euthyroid, hypothyroid or hyperthyroid.
Symptoms
- Eye Discomfort: Gritty sensation, redness, and excessive tearing.
- Swelling: Swelling of the eyelids and tissues around the eyes.
- Double Vision: Impaired eye movement can lead to double vision. Nerve damage does not go hand in hand with protrusion - if the eye cannot protrude nerve damage is more likely.
Signs
- Eye Bulging: Protrusion of one or both eyes, often referred to as exophthalmos.
- Proptosis: Forward displacement of the eyeball.
- Eyelid Retraction: Upper eyelids may appear elevated.
- Conjunctival Redness: Redness of the conjunctiva due to inflammation.
- Papilledema: increased pressure
- Photophobia: nerve involvement
Diagnostic Tests
- Clinical Examination: Ophthalmologists assess eye symptoms and perform a thorough eye examination.
- Thyroid Function Tests: Assessing thyroid hormone levels to determine if Graves’ disease is present.
- Imaging Studies: CT or MRI scans may be used to visualize eye and orbital structures.
Management
- Control of Thyroid Function: Managing hyper or hypo thyroidism
- Symptomatic Treatment: Lubricating eye drops, sunglasses, and elevation of the head during sleep (decrease periorbital oedema). to alleviate symptoms.
- Systemic Steroids: In severe cases, Prednisolone 30-120mg daily usually reduces inflammation
Complications/red Flags
- Optic Nerve Compression: Severe cases may lead to compression of the optic nerve, impacting vision.
- Corneal Ulcers: Reduced eyelid closure can lead to corneal exposure and the development of corneal ulcers.
- Cosmetic Concerns: Changes in eye appearance can have significant psychosocial effects.