Graves’ Related Eye Disease: Medical Treatment
Early eye symptoms, such as dryness, redness, itching, swelling of the lids and inability to wear contact lenses, are usually mild. Some patients find these symptoms to be particularly irritating at night and during exposure to air conditioning, hot air heating, and wind. A few patients will develop double vision (diplopia), which is the result of asymmetric inflammation of the muscles that control eye movement. Many patients develop mild symptoms that are often misdiagnosed as an "ocular allergy." Therefore, Graves' disease patients should be followed by an ophthalmologist familiar with the condition and available treatments. Patients with mild symptoms can often be successfully treated with frequent use of lubricating eye drops and wearing eye covers at night. Humidification of room air can prevent drying of the eyes, and wrap-around polarizing sunglasses can also help relieve glare. Diplopia can be improved by wearing special prism lenses while awaiting either spontaneous improvement or surgical correction. Temporary plastic prisms may be put on a regular set of eyeglasses and changed as needed. Prednisone, a steroid medication, may be taken in pill form to provide temporary relief from pain, swelling and redness, although side effects of the medication may limit its use.
Graves’ Related Eye Disease: Surgical Treatment
If ocular Graves' disease does not improve or if it gets worse despite treatment, surgery may be required. Retracted and puffy eyelids can change a person's appearance and increase the risk of the cornea drying. Corrective eyelid surgery can improve this problem through loosening of the eyelid muscles, as well as removal of scar tissue, excess fatty tissue and skin to place the eyelids into a more normal position. Surgery may also be necessary to correct diplopia when this problem has not improved either spontaneously or with prism lenses. Surgery to correct diploplia involves disconnecting and repositioning the muscles that control eye movement to improve ocular alignment and minimize double-vision.
The enlargement of tissue behind the eye may sometimes cause significant bulging of the eye (exophthalmos), which produces the characteristic wide-eyed stare seen in ocular Graves' disease. Swelling in the orbit may also contribute to vision loss as pressure increases on the optic nerve. Surgical procedures to reduce pressure on the optic nerve can improve vision and allow the eye to settle back to a more normal position. Orbital decompression is indicated in patients with significant exophthalmos, visual loss, or severe exposure of the corneas. Orbital decompression involves surgical removal of fat from behind the eyeball and may also involve removing some of the bone surrounding the eye socket.
For most patients, surgery is performed under general anesthesia and usually requires an overnight hospital stay.