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Dr Dansingani
Dr Dansingani, Ophthalmic Surgeon
Category: Eye
Satisfied Customers: 15
Experience:  BA, MA (Cambridge) MB,BS (London) FRCOphth (London)
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I have Graves Disease, and I have been having lots of eye

Resolved Question:

I have Graves Disease, and I have been having lots of eye problems, for almost a year now.
I have been seeing an Opthamologist(sp) and I have been doing eye scubs, omega 3 supplements, and azasite, . this seems to help but then the problems come back. My eyes are watery, red, irritated, gritty feeling, and they feel "oily". so, what do I do now?
someone mentioned a Rheumatilogist?
Submitted: 8 years ago.
Category: Eye
Expert:  Dr Dansingani replied 8 years ago.
Hi there,

There are six muscles involved in controling eye movement and a number of conditions can cause them to become enlarged.

The most common cause is probably thyroid eye disease, which is associated with Graves disease of the thyroid. It is an autoimmune condition in which the body's immune system attacks proteins on the thyroid gland causing it to go into overdrive.

Similar proteins happen to be found in the eye socket, and patients with Graves disease can develop inflammation in the eye socket which can affect the muscles. Because the eye socket is a confined space, any inflammation within it creates compressive symptoms.

Muscle function can be affected, leading to incorrect muscle balance and squint (the eyes being misaligned with respect to each other), giving double vision. It is also possible that the pressure in the socket displaces the eyeball forward causing the eyes to look 'prominent' and making the eyelids look retracted (widely open). The eyelids and soft tissue around the eyes can also look swollen.

The spectrum of severity can vary quite a lot from patient to patient. Some get very mild eye problems, others can have significant difficulties. The treatment of thyroid eye disease can therefore be complex and has to be tailred to each patient individually.

Options include:
  1. symptom relief with lubricating drops (for dryness)
  2. anti-infmmatory treatment with steroids or immunosuppressants
  3. surgery to relieve pressure in the eye socket
  4. prisms or surgery to address squint
  5. lid surgery to address lid function and appearance

The course of the thyroid eye disease can run over several years but typically the congestive flare-up phase is followed by a burn-out phase, in which inflammation gradually resolves, sometimes leaving scarring within the socket. Anti-inflmmatory treatment is often required during the congestive phase.

A rheumatologist may have been mentioned because they have expertise in administering and supervising immunosuppressants.

If your main symptoms are of dryness and surface discomfort, you may benefit from regular warm compresses to optimise the quality of the tearfilm. (Moist warm flannel applied to the closed eyes for 10 minutes at a time -- do not burn yourself!).

I hope the information is helpful. If so, kindly click the 'accept' link.

Thanks & best wishes.
Customer: replied 8 years ago.

Most of the info. that was given, I have researched myself and I have

been using lubricating drops(thera tears), doing warm comresses in the am and pm and doing eye washing. but it doesn't seem to help.

going on 1 year.

I feel tired, my eyes hurt.

so, my question was, do I need to see a rheumatologist or another type of a doctor.

Or do I just have to live this way?

Expert:  Dr Dansingani replied 8 years ago.
It's difficult to know without examining you in person. The 'ocular surface' symptoms are notoriously difficult to control in thyroid eye disease because there are so many contributing factors.

If you have a significant degree of proptosis (prominence of the globes), orbital decompression may alleviate your ocular surface symptoms. Decompression can be medical (steroids) or surgical. However both methods have their risks and side effects, and the specialists you see will always want to weigh these up against your symptoms.

The other complexity it that although the surface symptoms can be the most distressing, the best long term results are obtained by following the sequence of 'socket-squint-lids' (namely addressing surface symptoms as lower priority). It is simply not possible for me to get a feel for whether you require socket treatment or squint treatment without examining you personally.

The things I would look for in examining you are:
  1. vision, color vision and pupils
  2. eye movements
  3. exophthalmometry (measuring the proptosis)
  4. eye pressures
  5. degree of scler exposure (the white of the eye)
  6. lagophthalmos (does the eye close completely at rest)
  7. blepharitis and tearfilm quality
  8. cosmetic appearance
  9. stability/phase of the condition

I think the question about the rheumatologist or other type of doctor would best be answered by and ophthalmologist who has examained you and who has experience in dealing with thyroid eye disease.

Do you have to live with your symptoms? - To an extent yes. You will have to find a way to control and minimise your symptoms. Often they do not go away completely, and you may still have some long-term symptoms even at the end of the burnout phase.

I understand the prospect can be distressing but usually there are measures that can reduce the discomfort along the way. I hope it all goes well.
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