Ask an Eye M.D. Answer Archive

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Question:
Please advise on what to do for relief of eye pressure build-up from Graves' disease.
      
Answer:
Graves' ophthalmopathy, also known as thyroid eye disease (TED), is a complex autoimmune condition in which the body develops antibodies to the soft tissues behind the eyes. This may cause the muscles behind the eye to become swollen and stiff. This process may lead to eyelid retraction (stare), proptosis (bulging eyes), diplopia (double vision) and dry eyes. There may be an associated pressure sensation.

Patients with TED should consult an Eye M.D. and an endocrinologist to manage their care. Patients may be hyper-, hypo- or normal thyroid. Thyroid status must be normalized. This may be accomplished through the use of oral medication (Methimazole, Propylthyrouracil), radiation therapy (I-131), or surgery.

Smoking (if an issue) must be discontinued! The patient can use artificial tears or gel to soothe their eyes. Oral selenium and/or Singulair may be recommended. In more severe cases, patients may require oral or intravenous steroids, monoclonal antibody therapy (Rituximab) or even surgery.

The natural time course for TED is approximately 2 to 2 ½ years. During this time the eyes may worsen, plateau and then improve. Ensuring normalization of thyroid function will improve an individual’s outcome and time course.

It is important that patients with TED seek appropriate medical care by an Eye M.D. Treatment of TED includes many options such as: Lubrication of the eyes to compensate for exposure, eye muscle surgery if there is permanent double vision, eyelid surgery if exposure symptoms persist with lubrication, and orbital decompression surgery in advanced cases.

Answered by: Rona Silkiss, MD 

Dr. Rona Silkiss

Categories: Eye Diseases

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Answered: May 15, 2013

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