How is Graves’ Disease and Dry Eyes Linked

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One in three people who suffer from hyperthyroidism and are diagnosed with Grave’s disease will develop Graves’ eye disease. Affecting the small, butterfly-shaped gland located in the front of the neck, this autoimmune disorder causes hyperthyroidism. When the thyroid produces more thyroid hormone than the body needs, many different, unpleasant symptoms can occur.

What Are the Symptoms of Graves’ Disease?

Affecting about 1 in 200 people, Graves’s disease, if left untreated, can lead to heart problems, bone density loss, and dry eyes. Seven to eight times more common in women than men, this disease is more likely to develop for those age 30 to 50 and who have a family member who has the disease.

Common symptoms of hyperthyroidism linked to Graves’ disease include:

  • Rapid and irregular heartbeat
  • Diarrhea
  • Goiter
  • Intolerance to heat
  • Irritability or nervousness
  • Weak and tired muscles
  • Trembling hands
  • Rapid weight loss
  • Eye problems such as bulging eyes, double vision, swelling, and dry eyes

Which Health Conditions are Linked to Graves’ Disease?

More than likely, Graves’ disease is present in patients with other autoimmune disorders such as:

  • Rheumatoid arthritis
  • Pernicious anemia
  • Lupus
  • Addison’s disease
  • Celiac disease
  • Vitiligo
  • Type 1 diabetes

In addition to pairing with other autoimmune diseases, some very serious health problems can occur for those with Graves’ disease, such as osteoporosis and heart-related problems (irregular heartbeat, blood clots, stroke, and heart failure).

Graves’ ophthalmopathy (GO) is an eye disease that can cause sensitivity to light, double vision, eye pain, and even vision loss.

What Causes Graves’ Ophthalmopathy?

Researchers are unclear as to the exact cause of developing Graves’ disease, but some hypothesize that it may be a combination of a virus and family genes. An antibody created from the proposed virus attaches to thyroid cells causing the pituitary gland to overproduce thyroid hormones.

This overproduction of thyroid hormones attacks the tissues and muscles around the eyes. Inflammation and excess tissue buildup behind the eye socket cause the eyeballs to bulge out. In extreme cases, the inflammation is severe enough to cause vision loss from pressure placed on the optic nerve that sends signals to the brain.

Some symptoms of Graves’ Ophthalmopathy (GO) include:

  • Bulging eyes
  • Irritated eyes that feel dry and gritty
  • Retracted or puffy eyelids
  • Double vision
  • Sensitivity to light
  • Trouble with eye movements
  • Pain and pressure in the eyes

How Are Graves’ Disease and Dry Eye Syndrome Connected?

Dry eye disease (DES) is a separate condition and can often linger even after thyroid treatments have been successful at curing Graves’ disease. Often, doctors will treat the two problems separately with prednisone, eye drops, special eyeglass lenses, and even surgery.

DES affects the tear film that protects the ocular surface. When this tear film is compromised, ocular discomfort occurs. Blurred vision, burning, red, or gritty eyes many times accompany DES. This is a common disease even for those without an autoimmune disease or thyroid disorder. Onset of DES occurs usually a year to 18 months after GD symptoms are noticed.

Research has uncovered the particular mechanism behind the link of DES and GO. This understanding has led scientists to potential treatment options for both diseases.

Ophthalmologists will often perform a series of test to determine the severity and classification of DES. Schirmer tests, NOSPECS, Clinical Activity Score, and the VISA system, all help doctors devise a treatment plan that will help to elevate some of the discomfort of DES.

What Are Some Treatment Options for DES?

In order to successfully treat DES, patients must attack the root cause of dry eyes: an evaporated tear film. Researchers believe that the protective tear film of the eye evaporates due to a mechanical impairment of the eye lids. Hypertrophy of orbital muscles, fibrosis of certain muscle complexes, and an increase in orbital tissue and fat that surround the eyes can affect the complete closure of the eyelids.

When the eyelids do not close completely, the result is inadequate tear distribution. Therefore, treatment options should focus on adequate tear production. This can be found with surgery, orbital radiotherapy, and restoring tear volume and tear thickness.

Careful consideration for treatment options for GO should be thoroughly discussed between a patient and doctor.

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