Does Graves Ophthalmopathy Go Away?

Reviewed on 2/15/2022
Senior man with bulging eyes caused by Graves ophthalmopathy
Graves ophthalmopathy causes bulging eyes due to inflammation in the tissues around the eyes. Mild to moderate Graves' ophthalmopathy usually improves over the course of two to three years. 
  • Graves’ disease is an autoimmune disease that causes high levels of thyroid hormone in the body (hyperthyroidism).
  • The thyroid gland, located in the neck, makes thyroid hormone, which controls how the body uses and stores energy. In Graves’ disease, the body’s immune system mistakenly attacks the thyroid gland, causing it to grow and produce more thyroid hormone. 
  • Graves ophthalmopathy, also called Graves' eye disease or thyroid eye disease, is a condition in which the immune system attacks the tissues around the eyes causing the eye muscles or fat to expand. The eye muscles and connective tissue within the eye socket are vulnerable to Graves' eye disease because these tissues contain proteins that the immune system sees as similar to those of the thyroid gland. 
  • Graves' disease and Graves ophthalmopathy are both caused by an immune system attack on healthy tissue, but one disease does not directly cause the other. Each disease runs its separate course and they do not necessarily occur at the same time. This is why treating the thyroid gland does not improve thyroid eye disease. 
  • Mild to moderate Graves' ophthalmopathy will usually improve over the course of two to three years or patients will adapt to the abnormality. As symptoms increase, patients may fear losing their vision but most people will not go blind from Graves’ eye disease. About 10% of patients will be affected by severe ophthalmopathy. 

Treatment for thyroid eye disease generally occurs in two phases: 

  1. Treating the active eye disease
    • Treatment usually lasts two to three years 
    • Focuses on preserving sight and the integrity of the cornea 
    • Treats double vision when it interferes with daily functioning 
    • Artificial tears during the day and gels or ointments at night for dry eye relief
    • Use of eye covers at night or taping the eyes shut to keep them from becoming dry if the eyelids do not close properly
    • Prednisone to treat acute swelling causing double vision or loss of vision 
    • Radiation therapy to reduce swelling, double vision, and, in severe cases, loss of vision
    • Surgical decompression may be used during the active phase to relieve optic neuropathy, and to reduce congestion, redness, pain, and ocular exposure
  2. Treatment during the remission phase 
    • Lasts indefinitely in most cases
    • Involves correcting permanent changes that continue after the conditions of the active phase have stabilized
    • May include surgery 
      • To correct double vision 
      • To reduce eyelid retraction 
      • To return the eye to a normal position within the socket (orbital decompression)

Patients are also advised to stop smoking.

What Are Symptoms of Graves’ Ophthalmopathy?

Symptoms of Graves’ ophthalmopathy include eye inflammation and swelling that results in:

  • Eye pain
  • Eye redness 
  • Puffiness around the eyes
  • Bulging eyes
  • Dry eye and irritation, due to eyelids not closing completely over bulging eyes
  • Muscles around the eye tighten and lose their ability to stretch
    • Eye is pushed forward in its socket causing a “staring” appearance
    • Restriction of the eye’s normal movements that results in double vision

Progressive swelling may cause: 

  • Increased pressure inside the eye socket
  • Pressure-pain or deep headache
    • Worsens with eye movements
  • Reduced vision

What Causes Graves’ Ophthalmopathy?

In Graves’ disease, the body’s immune system mistakenly attacks the thyroid gland, causing it to grow and produce more thyroid hormone. The eye muscles and connective tissue within the eye socket are mistakenly attacked because these tissues contain proteins that appear similar to the immune system as those of the thyroid gland.

When the immune system attacks these ocular tissues, the inflammation causes swelling and scarring and the symptoms associated with the condition. 

Risk factors for developing Graves’ ophthalmopathy include: 

  • Being female
    • Women are five to six times more likely than men to develop the disease
  • Smoking

How Is Graves’ Ophthalmopathy Diagnosed?

Graves’ ophthalmopathy is diagnosed with a medical history and perform a physical examination. If an overactive thyroid gland is suspected, thyroid function is evaluated.

For those diagnosed with hyperthyroidism, Graves’ eye disease may be diagnosed by an eye examination in which a doctor finds swelling and enlargement of the eye muscles. 

Imaging tests of the eye muscles may also be used: 

Reviewed on 2/15/2022
Image Source: iStock Images