- CONJUNCTIVITIS(inflammation of the inner eye-
lids) - diminished visual acuity (blurry or distorted
vision) - PHOTOPHOBIA(sensitivity to light)
- excessive tearing
As these symptoms are distinctive for Graves’s
ophthalmopathy, the doctor often can make the
diagnosis based on their presentation. Tests of thy-
roid HORMONElevels in the BLOODconfirm Graves’s
disease, if not already diagnosed. Conventional
OPHTHALMIC EXAMINATIONand SLIT LAMP EXAMINATION
allow the ophthalmologist to assess the status of
vision and health of the structures of the eye. A
COMPUTED TOMOGRAPHY(CT) SCANhelps assess the
extent of orbital swelling and compression of the
optic nerve.
Treatment Options and Outlook
The course of Graves’s ophthalmopathy seems to
unfold in two stages, regardless of treatment for or
status of the underlying hyperthyroidism. The first
stage is the acute or active phase, during which
symptoms emerge. During this stage, which
extends over 18 to 30 months, ophthalmologic
treatment focuses on reducing pressure on the eye
and stabilizing vision, and may include
- ophthalmic lubricating drops or ointment to
keep the cornea hydrated - patching the eyes at night to protect the
corneas during sleep - NONSTEROIDAL ANTI-INFLAMMATORY DRUGS(NSAIDS)
to reduce inflammation and relieve discomfort - CORTICOSTEROID MEDICATIONS to suppress the
body’s immune response- ANTIBIOTIC MEDICATIONSto treat bacterial infec-
tion of the eyelids (BLEPHARITIS), conjunctiva
(conjunctivitis), and cornea (keratitis)
- ANTIBIOTIC MEDICATIONSto treat bacterial infec-
In the second stage of Graves’s ophthalmopa-
thy, the progression of symptoms ends. However,
the changes that have occurred are permanent.
Fibrous deposits replace lymphocytes in the eye
muscles, maintaining their enlargement and con-
tinuing the exophthalmos. Treatment in this stage
targets minimizing these permanent consequences
through surgeries to relieve the pressure within
the orbit (orbital decompression), reduce the size
of the extraocular muscles (myectomy), and
reconstruct the eyelids so they close completely
over the eye (BLEPHAROPLASTY). Corneal reshaping
(keratoplasty) or CORNEAL TRANSPLANTATIONmay be
necessary to restore vision when damage to the
cornea is extensive. If infection resulted in loss of
the eye, the ophthalmologist will place a PROS-
THETIC EYE.Risk Factors and Preventive Measures
Graves’s ophthalmopathy occurs only in conjunc-
tion with thyroid disorders, nearly always hyper-
thyroidism. It may appear months to several years
before other clinical indications of hyperthy-
roidism, or a comparable time after beginning
treatment for hyperthyroidism. Prompt diagnosis
and treatment are essential to preserve vision, as
the changes that occur with Graves’s ophthal-
mopathy are generally permanent. An ophthal-
mologist should evaluate any changes in the
appearance of the eyes. Regular eye examinations
help screen for Graves’s ophthalmopathy as well
as other eye health problems.
See also AUTOIMMUNE DISORDERS; BACTERIA; VISION
HEALTH.Graves’s ophthalmopathy 95