How does Graves' disease affect the eyes?

Dr. Jeanne Morrison, PhD
Family Practitioner

Graves' disease, the leading cause of hyperthyroidism, causes bulging eyes and double vision. The orbits of the eyes swell and become inflamed, which then leads the eyes to bulge. Movement of the eye muscles becomes impaired due to the inflammation. This leads to the difficulty or inability to control eye movement, which results in double vision. Sometimes the eyes cannot be completely closed, leading to dry eyes and the increased likelihood of dust or other particles irritating the eyes. A person with this condition may have to tape their eyelids shut at night.

Graves’ disease can affect your eyes in many different ways. The symptoms may vary from person to person and may fluctuate or clear up suddenly without any treatment. Following are several common eye problems associated with the disease:

Eye protrusion: The excess hormones in Graves’ disease cause the muscles in and around the eye to swell and push the eye forward. This eye bulge is a characteristic symptom of Graves’ disease and causes patients to look as if they are constantly staring.

Eyelid retraction: The combination of eyelid swelling and eye protrusion may cause the eyelids to retract and reveal the white parts of the eye above and below the iris.

Dry eye: Due to eye protrusion and eyelid retraction, your eyes are more exposed to environmental elements, such as wind and dust, and may become very dry. Dry eye can cause several side effects, including:

  • Irritation and discomfort of the eye
  • Inflammation of the eye
  • Excessive tearing
  • Light sensitivity
  • Blurred vision
  • Ulcers on the cornea (the clear front window of the eye)
  • Scarring of the cornea

If untreated, severe dry eye can lead to vision loss.

Double vision: Muscle swelling may cause double vision. It may occur constantly or only when looking in certain directions. Prolonged and excessive muscle swelling can also compress and damage the optic nerve (the nerve in the eye that sends visual impulses to the brain) and in severe cases cause blindness.

Eye “bags”: Eyelid swelling can also cause fatty tissue around the eyes to bulge forward. This causes the appearance of “bags” around the eyes and can make patients look prematurely aged.

Graves' disease can affect the eyes in a number of ways, including the following problems with three components of vision:

  • Blurred vision can reflect dryness of the eye or damage to the optic nerve. An ophthalmologist can test clarity of vision and examine the cause.
  • Decreased color vision, particularly red color, is an early sign of vision loss in Graves' disease. A good way to test decreased color vision is to alternate covering one eye and seeing if a red object looks different from one eye to another. If this is the case, an oculoplastic surgeon or neuro-ophthalmologist should be seen as soon as possible.
  • Problems with field of vision could reflect a problem with the optic nerve. An ophthalmologist can look for problem spots in a person's field of vision performing a visual field test.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.