Know the symptoms that can signal Graves eye disease


If PDD is not treated, the inflammation can get worse. Progressive swelling can cause increased pressure and pain in the back of the eye socket, which gets worse with eye movement. The eye muscles can also contract and hinder eye movement, which can lead to double vision. “If the swelling due to the accumulation of tissue in the eye socket is severe enough, the pressure can cause compression of the optic nerve. , resulting in progression of vision loss, ”says Matthew Zhang, MD, oculoplastic surgeon at the Seattle Eye Institute in Harborview and assistant professor of ophthalmology at the University of Washington.

In the later stages, you may have a bulging or bulging eye because the muscles and soft tissue behind the eyeball swell, pushing the eye forward.

There are two phases to the disease. When PDD is in its active and inflammatory phase, symptoms such as sore, rough, and swollen eyes can last from six months to two years. But for most people, things will calm down and improve on their own. The second phase is the stable phase where the active inflammation subsides. “The disease will go away on its own,” said Zhang. “But often patients will end up with some degree of eye protrusion, eyelid retraction, or double vision that requires medical attention.”

Quality of life issues

Not all challenges are physical. According to a survey of physicians treating PDD, patients have difficulty functioning in social situations, with about a third suffering from anxiety and / or depression. Problems with eye alignment and double vision, in particular, can affect the quality of life. “Double vision can put you out of action – you can’t drive or do normal activities,” says Winokur. “And there are people who constantly suffer from dry eyes. They use eye drops and get relief for five minutes, then go to the computer and can’t work.

Fortunately, help is available. The Graves’ and Thyroid Foundation offers online resources and support groups for people with thyroid eye disease, including

Relieve eye discomfort

A doctor (who suspects that you have Graves’ eye disease) will first examine your thyroid for abnormalities and make sure that an overactive thyroid – if this is is the cause – is well controlled with anti-thyroid drugs. However, although Graves’ disease and ocular thyroid disease share a similar biology – both are caused by the immune system attacking healthy tissue – one does not necessarily cause the other. PDD can occur when thyroid levels are high, normal, or low.

For people with mild PDD, a few simple steps can ease the discomfort. Putting on a pair of sunglasses can help with light sensitivity. Adding prisms to your glasses can eliminate double vision.

The irritation can be managed with cold compresses, over-the-counter artificial tears, or prescription eye drops to stimulate tear production, or eye gel at night. “If the eye is pushed forward and more prominent, you can’t close your eyelid properly when you sleep,” says Pearce. “A lubricating gel can protect the surface of the eye.

Oh, and if you smoke, consider this other reason to quit: “Smokers with Graves’ disease are about twice as likely to develop PDD as those who don’t smoke, and smoking makes PDD worse.

There is also recent evidence that selenium, a mineral primarily found in grains and nuts, may be helpful. “If a patient’s diet is low in selenium, we may recommend that they eat Brazil nuts, which contain a high amount of selenium,” says Pearce. “It’s also an antioxidant, so it helps fight inflammation in the eyes. Or we can give them a mineral supplement that contains selenium.

Treatments assisted by a doctor

Corticosteroids. For more aggressive symptoms, your doctor may suggest corticosteroids (especially prednisone) to reduce inflammation. “Eyes that are inflamed – lots of redness, itching and tearing, swelling of the eyelids or the whites of the eyes and grains of sand – can be treated very well with steroids,” says Pearce.

Tepezza. Another option is Tepezza, approved by the FDA in 2020 as the first prescription drug to treat ASD. It is given intravenously into your arm every three weeks for a total of eight times. Tepezza stops the growth of muscles and soft tissues behind the eye to reduce eye swelling, double vision, and pain. Promising, sure, but you’ll want to talk to your doctor about it. On the one hand, there can be side effects. (Recently, more than half of participants in a small study suffered hearing loss to varying degrees after being treated.) And there’s the jaw-dropping price tag: Tepezza is estimated at $ 1,500 per vial. , with treatment costing approximately $ 200,000. Insurance coverage and reimbursable patient costs vary by insurance plan.

Surgery. Ultimately, even after TED is under control, people may need rehabilitation surgery to correct the appearance of their eyes – to return the eye to its previous shape.

  • Orbital decompression surgery is usually performed when pressure on the optic nerve threatens vision. An endoscope is carefully maneuvered through the nose and sinus near the eyes, and pieces of bone and tissue are removed to give the eye more room to snap back into place. part of the compression around the optic nerve, ”says Winokur. A pair of outpatient procedures, performed under local anesthesia, can tackle other problems.
  • Eye muscle surgery is performed when scar tissue, which forms around the eye muscles, becomes stiff, causing eye misalignment and leading to double vision. A surgeon reposition the muscles, aligning the eyes.
  • Eyelid repositioning surgery can help when the eyelid muscles are too tight, causing the eyelids to open too wide. The muscles or tendons in the eyelid are released, allowing the eyelid to return to a more natural position.

Even after corrective surgeries are over, you may end up with unwanted memories. “Because your eyelids swell with inflammation and fluid, and because you probably rub them a lot,” says Pearce. “It stretches the skin.” People often find themselves with saggy and swollen eyes. The swollen and swollen tissue around the eye can be tightened by blepharoplasty (more commonly called an eye lift). Laser resurfacing and injections, like Restylane, can give saggy skin a boost.

Barbara Stepko is a longtime health and lifestyle writer and former editor of Women’s health and In the style. His work appeared in The Wall Street Journal, Parade and other national magazines.


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