Graves' ophthalmopathy

In Graves' ophthalmopathy, the eyeballs stick out farther than normal because the tissues and muscles behind the eyes become swollen. It can develop before, after, or at the same time as other signs of hyperthyroidism. Graves' ophthalmopathy occurs in about 40% of people who have Graves' disease.¹

See a picture of Graves' ophthalmopathy.

Most people who develop Graves' ophthalmopathy have one or more of the following symptoms:

• Dry, itchy, irritated eyes
• A staring or bug-eyed look
• Sensitivity to light; watery, teary eyes; and a feeling of pain or pressure around the eyes
• Difficulty closing the eyes completely
• Double vision, especially when looking to the sides

A small number of people have symptoms because the tissues around their eyes are inflamed (acute inflammatory thyroid eye disease). These symptoms include:

• Swelling of the eyelids and tissues around the eyes, especially in the morning.
• Swelling of the membrane that covers the eyeball and lines the eyelid.
• Pain when moving the eyes up and down and from side to side.

Most mild problems caused by Graves' ophthalmopathy go away on their own within 1 to 4 months. Graves' ophthalmopathy may also get better if you take antithyroid medication.

You will likely have an eye exam to make sure you do not have another eye problem, such as a tumor.

To help decrease dryness and discomfort, your doctor will treat your symptoms of Graves' ophthalmopathy with artificial tears, medicated eyedrops, and protective glasses or sunglasses. If the condition is diagnosed early, you can use nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and naproxen, to relieve pain and inflammation.

If you have severe inflammation of the muscles and tissues around your eyes, you may need corticosteroid medications, immunosuppressants, or radiation therapy. Surgery is only done if you have serious vision problems or nerve damage, or if you want to change the way your eyes look.

Ophthalmopathy may get worse if your thyroid levels are out of balance. It may also get worse temporarily if you are given radioactive iodine therapy.

Smoking increases your chances of developing Graves' ophthalmopathy, and it can make the condition worse.