Graves’ disease is a disorder that leads to the overproduction of the thyroid hormones (hyperthyroidism). Graves’ disease can affect one’s overall wellbeing. Many people with Graves’ disease suffer from Graves’ ophthalmopathy.

The thyroid gland is positioned in front of the neck. It is responsible for synthesising hormones that control metabolism. This is how the body converts food into energy. Some people suffer from a condition where the body’s immune system goes against their thyroid gland. This causes their thyroid gland to produce too much hormone, and as a result, affects the tissue and muscles surrounding the eyes.

Also Known As

  • Thyroid eye disease (TED)
  • Dysthyroid/thyroid-associated orbitopathy (TAO)
  • Graves' orbitopathy (GO)
  • Graves' ophthalmopathy

Causes and Risk Factors

Thyroid eye disease develops when certain carbohydrates accumulate in the tissues and muscles of the eyes. While the cause of this condition is unknown, it is likely that the antibody that causes thyroid dysfunction is attracted to tissues around the eyes.

Graves’ ophthalmopathy develops during the same time that hyperthyroidism appears. However, the signs and symptoms of thyroid eye disease may appear a few years before or after the manifestation of hyperthyroidism. Thyroid eye disease may also develop even where there is no hyperthyroidism.
There are a few factors that increase one’s risk of getting Graves’ ophthalmopathy. These factors include:

  • Family history – People with a family history of Graves’ disease are likely to suffer from the disorder.
  • Age – Graves’ disease is common in people who are below 40 years.
  • Gender – Women are more likely to suffer Graves’ disease than men.
  • Pregnancy – Recent childbirth or pregnancy increases the likelihood of the disorder especially among women who have a family history with the disease.
  • Autoimmune disorders – People suffering from immune system disorders like rheumatoid arthritis and type 1 diabetes are at a high risk of getting Graves’ disease.
  • Physical/Emotional stress – Illness or stressful life occurrences can trigger Graves’ disease among those who have a genetic susceptibility of suffering from the condition.
  • Smoking – Smokers have a high risk of suffering from Graves’ ophthalmopathy.

Signs & Symptoms

The primary symptoms of Graves’ ophthalmopathy are:

  • Bulging eyes – Too much thyroid hormone results in the eye muscles swelling and pushing the eye forward. The affected person will have bulging eyes.
  • Eyelid retraction – When the eye muscles swell, the upper and lower eyelids appear retracted. As a result, the white parts of a person’s eye are more visible.
  • Vision changes – The swollen eye muscles cause double vision. The swelling pressurises the optic nerve. This nerve connects the eye and the brain. When this nerve is damaged, it results in blindness.
  • Dry eye – When the eyelids are protruding and retracted, they are vulnerable to wind and dust. As a result, the eyes become dry. A person with dry eyes has blurred vision. They are also sensitive to light, and eventually, their cornea (clear, front window of the eye) may be damaged.
  • Eye bags – When the patient’s eyelid swell, the tissues around their eyes bulge and they look like bags surrounding the eyes.


The eye care professional may probably perform an eye exam to determine whether a person has Graves’ ophthalmopathy. This may involve a simple blood test to check the patient’s thyroid levels. To confirm his/her diagnosis, the eye care doctor may conduct a computed tomography (CT) scan or a magnetic resonance imaging scan (MRI) to look for swelling around the tissues of the eye.


Treatment of Graves' ophthalmopathy is aimed at addressing eye bulging and retraction and restoring normal vision.

Medical Treatment

  • Steroids – Swelling of the eyes may be relieved through the use of steroids such as prednisone and hydrocortisone.
  • Lubricating eye drops – Artificial tears can help relieve scratchiness and dryness. The patient may also use a lubricating gel before heading to bed to keep the cornea moist since the eyelids may not be able to cover the entire eye.
  • Wearing sunglasses or prisms – To reduce exposure to ultraviolet rays, the eye doctor could ask the patient to wear sunglasses to protect their eyes from the sun. Prisms may be prescribed for patients with double vision.

Surgical Treatment

  • Eyelid surgery – The surgeon will perform surgical repositioning of the patient’s eyelid to reduce irritation and tearing caused by bulging eyes.
  • Eye muscle surgery – The surgeon will perform eye muscle surgery to rectify double vision which is caused by scar tissue that affects the eye muscles.
  • Orbital decompression surgery – In severe cases, where vision loss is likely to occur, the surgeon will perform orbital decompression surgery. In this surgical treatment, the bone between the eye socket (orbit) and sinuses are taken out to make room for swollen tissues. This procedure improves vision and makes room for the eye to regain its normal position.

Home Care

  • Applying cold compresses to the eyes - This extra moisture provides relief.
  • Elevate the head above the body - Keeping the head elevated may relieve pressure on the patient’s eyes and reduce swelling.

Prognosis/Long-term outlook

Most of the symptoms of thyroid eye disease can be treated successfully.

Prevention/Follow Up

Graves’ ophthalmopathy cannot be prevented. Affected persons are advised to avoid radioiodine therapy because it worsens the condition. Treatment through surgery or antithyroid drugs is preferable. If radioiodine treatment is used, patients can use corticosteroid drugs like prednisone to prevent aggravating the disease.

Smokers are more prone to developing thyroid eye disease than nonsmokers and are therefore advised to quit smoking. Second-hand (passive) smoking is also a risk factor and so people should avoid staying next to active smokers.

Smokers are susceptible to Graves' Ophthalmopathy than nonsmokers. Second-hand exposure to smoke has the same effect as active smoking and should also be avoided.