Thyroid Eye Disease


Graves' disease, or thyroid eye disease, is the most common cause of proptosis (bulging eyes) in adults. This is a disease which effects the thyroid gland and the tissues of the orbit. Middle-aged and elderly women are somewhat more commonly affected by this disease, which can cause swelling of the orbital tissue and eyelid retraction leading to a staring appearance.

In severe cases, proptosis can lead to corneal surface irregularities, infection, and scarring, resulting in permanent visual loss. Double vision can occur as swollen extraocular muscles become restricted. Other common signs and symptoms include redness, burning, and tearing.

Complications of the Disease

The most devastating complication of Graves' disease is visual loss from optic nerve damage. As the muscles enlarge in the confined space of the orbit, they can press on the optic nerve resulting in a gradual loss of vision. The earliest sign of optic nerve damage is loss of color vision.

As the manifestations of thyroid disease are so variable, the treatment must be tailored to the individual patient. All patients must be evaluated by an endocrinologist to assess their thyroid gland function. The thyroid status does not always parallel the ocular disease in time-course or severity, therefore it is important that all patients be followed by an eye doctor and endocrinologist for life.


Treatment of the early symptoms of redness, burning, and corneal irritation includes artificial tear drops during the day and lubricating ointments at bedtime. Severe proptosis or optic nerve damage is best managed with orbital decompression, a procedure designed to expand the volume of the orbit into the adjacent sinuses, relieving pressure from the optic nerve and allowing more room for the eye to settle back into the head.

Imbalance of the muscles resulting in double vision is best treated with surgery to realign the eyes. The corneal irritation and cosmetic deformity caused by eyelid retraction is corrected through surgery designed to lengthen the eyelids. This is quite effective at improving ocular comfort and eliminating the staring appearance.