Will My Eyes Ever Go Back to Normal After Graves' Disease?

Graves' disease is an immune system disorder that leads to thyroid hormones being produced in excess. This is known as hyperthyroidism. Its symptoms include a fast or irregular heartbeat, increased feelings of nervousness, irritability or anxiety, and weight loss.

While Graves' disease can cause many symptoms in various areas of the body, roughly 25%–50% of people will develop symptoms affecting their eyes, known as Graves' disease ophthalmopathy.

This article discusses the eye health consequences of Graves' disease and whether treatment can return eye health to normal. 

Bulging Eyes

Because Graves' disease is an immune system disorder, the body’s immune system attacks healthy thyroid cells. When this happens, damage to the muscles and fatty tissues behind the eye can cause them to swell and bulge. When eye functioning is negatively impacted, it can lead to other eye issues.

For example, a person with bulging eyes (known medically as proptosis or exophthalmos) caused by Graves' disease may also experience dry eyes, because the symptom makes it more difficult to blink. Other eye symptoms that can occur include sensitivity to light and gritty-feeling eyes.

Treatment

Treating Graves' disease eye effects requires a multifaceted approach. Typically, a person suffering from eye symptoms from Graves' disease will need to see more than one specialist. Healthcare providers that may be involved in treatment include:

• An opthalmologist, a medical doctor (MD) who specializes in eye diseases
• An endocrinologist, who specializes in treating disorders that affect glands and organs responsible for hormone production
• A radiologist, who specializes in imaging procedures such as X-rays, CT (computed tomography) scans, and MRI (magnetic resonance imaging) scans
• An optometrist, who specializes in diagnosing and examining the eyes and visual system in the body 
• An orthoptist, who specializes in eye care and works with an ophthalmologist
• General practitioner, who specializes in general medicine and is often known as a person’s primary care provider (PCP)

Some aspects of care that are used for the eyes include:

• Corticosteroids, which are designed to reduce swelling in the eye area
• Immunosuppressant medications that hinder the action of the immune system
• Supplementing with the mineral selenium
• Orbital radiotherapy, which is a type of therapy designed to decrease inflammation and, in turn, reduce eye symptoms
• Surgical orbital decompression, which is a type of surgery designed specifically to relieve bulging eyes
• Eye lubricants

Tepezza (teprotumumab-trbw), the first treatment for thyroid eye disease, approved by the Food and Drug Administration in 2020, can help reduce bulging eyes.

Is Graves' Disease Curable?

Graves' disease isn’t curable. However, a person with the disease can receive adequate treatment that will rebalance their thyroid hormones and essentially rid them of their symptoms.

The disease itself is a lifelong condition that requires medication to manage symptoms. Since symptoms come and go, it’s important to choose the right medication course and speak to your healthcare provider about what to expect during and following your treatment.

Typically, the use of antithyroid drugs, which are designed to hinder the production of thyroid hormones, are the most effective treatment for Graves' disease as a whole and are considered to be as close to a cure as possible for this type of disorder.

One study looked at the remission rate of Graves' disease using antithyroid drugs and how long the effects lasted. On average, 50% of study participants who went into remission during the two-year medication period remained in remission for up to four years, and at 12 years following their treatment course, 45% also remained in remission.

Complications

When a person has eye involvement in Graves' disease, their symptoms may come with a host of eye health complications. Those include:

• Dry, irritated eyes
• Red eyes
• Double vision (diplopia)
• Pain when moving the eyes
• Eyelid retraction, which is when lower eyelids retract or fall too low on the eye
• Eye protrusion, or bulging, which is when the eyes bulge out of their sockets
• Lid lag, which is when the upper eyelid sits in an abnormal position when a person is looking down
• Signs of an eye infection, such as swelling or blisters, otherwise known as chemosis
• Enlarged vessels in the conjunctiva, which lines the inner eyelids and eyeball
• A yellow growth or mass forming underneath the conjunctiva
• Swelling of the eye socket
• Inflammation of the eye muscles
  

Living With Graves' Disease

Living with Graves' disease can be difficult because of the variety of symptoms that can occur. When you're diagnosed, it’s important to seek out the proper treatment.

Talk to a healthcare provider about the various treatment options for optimal symptom relief. Once you do find a treatment that works for you, you will likely go into remission.

Aside from finding the proper treatment, you can also make efforts to live your life as healthily as possible. Some measures you can take to help cope with symptoms of Graves' disease include:

• Dietary changes: Eating foods high in iodine may make the condition worse. This is because your thyroid uses iodine to make thyroid hormones. Avoiding foods with high levels of iodine, such as seaweed or kelp, can be helpful.
• Counseling: In some cases, especially with eye involvement, symptoms can take a toll on your mental health. Speaking to a professional about the emotional repercussions of Graves' disease can help you manage the negative mental effects of the condition.
• Sleep well: Sleep is vital for overall health, but it can be difficult to get good sleep when you have eye symptoms of Graves' disease. To get a better night’s rest, you can tape your eyelids shut or keep your head elevated. This will help to keep the eyes closed, moisturized, and more comfortable.
• Quit smoking: Smoking can make the eye symptoms worse and make treatment to be less effective.  

Summary

Graves' disease is an autoimmune condition that can cause various symptoms. In as many as half of cases, the disease affects the eyes and leads to bulging eyes, dry irritated eyes, blurred vision, and, in rare cases, vision loss, which can be difficult to cope with.

There are viable treatment options for both Graves' disease as a whole, as well as the eye symptoms that can arise. With proper treatment, a person with the disease can experience reduced symptoms as well as full remission. While remission doesn’t last forever and symptoms can come and go, the right medication can keep a person symptom-free for longer.

A Word From Verywell 

Dealing with eye issues caused by Graves' disease isn’t easy, but there are viable options available to you. Graves' disease is treatable, even if it’s something you have to manage for the rest of your life. Contact a healthcare provider to seek proper treatment, consider finding a support group, and practice healthy habits so that you can experience symptom relief for longer periods of time.