Summary about Disease
Graves ophthalmopathy (also known as thyroid eye disease or Graves' orbitopathy) is an autoimmune condition associated with Graves' disease (an autoimmune disorder causing hyperthyroidism). It causes inflammation and swelling of the muscles and tissues around the eyes. This can lead to a range of symptoms, from mild irritation to vision-threatening complications. It is important to note that even when thyroid levels are controlled, the eye disease can progress or persist.
Symptoms
Symptoms vary in severity and can include:
Dry, gritty, or irritated eyes
Redness of the eyes or eyelids
Excessive tearing or watery eyes
Swelling of the eyelids
Bulging eyes (proptosis or exophthalmos)
Double vision (diplopia)
Difficulty moving the eyes
Pain or pressure in the eyes
Sensitivity to light (photophobia)
Blurred vision
Vision loss (rare, but possible)
Causes
Graves ophthalmopathy is an autoimmune disease. The body's immune system mistakenly attacks the tissues surrounding the eyes, particularly the muscles and fat behind the eyeball. This leads to inflammation, swelling, and tissue remodeling. While strongly associated with Graves' disease, it can sometimes occur before or after the onset of hyperthyroidism, or even in people with normal thyroid function. The exact triggers for the autoimmune response are not fully understood, but it's thought that antibodies directed against the thyroid gland also cross-react with eye tissues because of similarities in certain proteins.
Medicine Used
Treatment options depend on the severity of the disease. Some common medications include:
Artificial tears and lubricating ointments: To relieve dry eye symptoms.
Corticosteroids (e.g., prednisone): To reduce inflammation.
Immunosuppressants (e.g., azathioprine, methotrexate): To suppress the immune system.
Teprotumumab (Tepezza): An antibody that specifically targets the insulin-like growth factor-1 receptor (IGF-1R), showing significant promise in reducing proptosis and other symptoms.
Selenium supplements: May be beneficial in mild cases. Other treatments may include:
Orbital decompression surgery: To create more space for the swollen tissues behind the eye.
Eye muscle surgery: To correct double vision.
Eyelid surgery: To improve eyelid closure and protect the cornea.
Radiation therapy: Can sometimes be used to reduce inflammation.
Is Communicable
No, Graves ophthalmopathy is not communicable. It is an autoimmune disease, meaning it is not caused by an infectious agent and cannot be spread from person to person.
Precautions
Manage thyroid levels: Maintain normal thyroid hormone levels, as this can help stabilize the eye disease.
Quit smoking: Smoking significantly worsens Graves ophthalmopathy.
Protect your eyes from the sun: Wear sunglasses.
Use artificial tears: To keep eyes lubricated, especially if you have dry eyes.
Elevate your head while sleeping: To reduce swelling around the eyes.
See an ophthalmologist regularly: For monitoring and treatment.
How long does an outbreak last?
The active inflammatory phase of Graves ophthalmopathy typically lasts for 6 months to 2 years. After this active phase, the condition usually enters a stable, but often altered, state. Some symptoms may persist, even after the active inflammation has subsided. Treatment aims to shorten the active phase and minimize long-term complications.
How is it diagnosed?
Diagnosis involves a combination of:
Physical examination: Assessing eye movement, eyelid position, proptosis (bulging of the eyes), and visual acuity.
Blood tests: To check thyroid hormone levels (TSH, T3, T4) and thyroid antibodies.
Imaging studies:
CT scan or MRI of the orbits: To visualize the eye muscles and fat, and identify inflammation.
Clinical Activity Score (CAS): to assess the current inflammation.
Timeline of Symptoms
The timeline of symptoms can vary considerably. It usually unfolds in stages:
Early Stage: Mild irritation, dryness, and redness are often the first symptoms.
Active Phase: Inflammation increases, leading to swelling of the eyelids, proptosis, double vision, and pain. This phase typically lasts for 6 months to 2 years.
Stable Phase: Inflammation subsides, but some symptoms may persist. The eye muscles and tissues may remain enlarged, leading to persistent proptosis or double vision.
Progression: Some individuals might see slow progression of the illness.
Important Considerations
Severity: Graves ophthalmopathy ranges from mild to severe, and treatment should be tailored to the individual's needs.
Smoking: Smoking is a major risk factor and can significantly worsen the disease. Quitting smoking is crucial.
Multidisciplinary care: Management often involves collaboration between endocrinologists (to manage thyroid disease) and ophthalmologists (to manage the eye disease).
Psychological Impact: The change in appearance and potential vision problems can have a significant psychological impact. Support groups and counseling can be helpful.
Euthyroid: Maintain euthyroid state after the completion of treatment for hyperthyroidism to prevent progression.