Graves ophthalmopathy

Graves' ophthalmopathy, also known as thyroid eye disease (TED), is an autoimmune inflammatory disorder that affects the tissues around the eyes. The condition can cause a range of symptoms, including:

• Bulging eyes (exophthalmos)
• Upper eyelid retraction
• Lid lag
• Swelling and redness (erythema) in the orbit and surrounding tissues
• Conjunctivitis (inflammation of the conjunctiva)
• Pressure or pain in the eyes

The symptoms can vary in severity, but in some cases, they can be severe enough to cause vision loss. Graves' ophthalmopathy is often associated with hyperthyroidism due to Graves' disease, but it can also occur in people with normal or low thyroid levels.

In its severe form, Graves orbitopathy can lead to:

• Proptosis (bulging of the eyes)
• Diplopia (double vision)
• Ptosis (drooping eyelid)
• Enophthalmos (sunken eye)

The condition is often treated with medication, such as steroid injections or oral steroids, and in some cases, surgery may be necessary to relieve pressure on the optic nerve.

References:

• [2] Graves' ophthalmopathy, also known as thyroid eye disease (TED), is an autoimmune inflammatory disorder of the orbit and periorbital tissues...
• [8] Graves orbitopathy (Graves eye disease or Graves ophthalmopathy) is a constellation of signs and symptoms related to the orbit and surrounding tissues in patients with Graves disease.
• [9] Thyroid-associated orbitopathy (TAO), frequently termed Graves ophthalmopathy, is part of an autoimmune process that can affect the orbital and periorbital tissue...

Common Signs and Symptoms of Graves' Ophthalmopathy

Graves' ophthalmopathy, also known as thyroid eye disease, is a condition that affects the eyes and is often associated with an overactive thyroid gland. The symptoms can vary from person to person, but here are some common signs and symptoms:

• Redness: Redness and swelling of the eyelids, particularly in the upper eyelid [3].
• Dry Eye (Grittiness) or Excessive Tearing: Feeling of grittiness in the eyes, like "sand in your eyes," or excessive tearing [5].
• Swelling/Puffiness: Swelling and puffiness around the eyes, which can be tender to the touch [6].
• Pain: Pain or discomfort in the eyes, particularly when moving them or applying pressure [5].
• Double Vision: Double vision or blurred vision due to misalignment of the eyelids or other eye muscles [3].
• Sensitivity to Light: Sensitivity to light and increased tearing [8].

Other Signs and Symptoms

In addition to these common symptoms, some people may experience:

• Upper Eyelid Retraction: The upper eyelid is retracted, making it difficult to close the eye completely [4].
• Edema and Erythema: Swelling (edema) and redness (erythema) of the periorbital tissues and conjunctivae [4].
• Stellwag Sign: Incomplete and frequent blinking [7].
• Grove Sign: Resistance in pulling the retracted upper eyelid [7].
• Boston Sign: Jerky movement of the eye when trying to move it from side to side [7].

It's essential to consult a healthcare professional if you experience any of these symptoms, as they can be indicative of an underlying condition that requires medical attention.

References: [3] - Sep 28, 2022 — What are the signs and symptoms of thyroid eye disease? [4] - by RS Bahn · 2010 · Cited by 1726 — The most common clinical features of Graves' ophthalmopathy [5] - (Also Known as Graves' Ophthalmopathy or Graves' Orbitopathy) [6] - 7 Signs and Symptoms of Thyroid Eye Disease (Graves' Ophthalmopathy) [7] - by R Gandhi — Signs [8] - Thyroid Eye Disease vs Graves' disease

Diagnosing Graves' Ophthalmopathy

Graves' ophthalmopathy, also known as thyroid eye disease, is a condition that affects the tissues around the eye in people with Graves' disease. Diagnosing this condition can be challenging, and it often requires a combination of clinical evaluation and laboratory tests.

• Clinical Evaluation: A diagnosis of Graves' orbitopathy is typically made based on clinical findings, such as eyelid retraction, exophthalmos (bulging eyes), and restrictive extraocular myopathy (weakness or paralysis of the eye muscles) [3].
• Thyroid Function Studies: While thyroid function studies can be helpful in diagnosing Graves' disease, they may not always be abnormal in patients with Graves' orbitopathy [8]. However, measuring antibodies such as TRAb or TSI can be a cost-effective initial diagnostic test [7].
• Imaging Studies: Imaging studies, such as ultrasound or CT scans, may be used to evaluate the extent of orbital involvement and rule out other conditions that may mimic Graves' orbitopathy.
• Laboratory Tests: Laboratory tests, such as blood tests, may be used to measure thyroid hormone levels and detect the presence of thyroid antibodies.

Key Points

• A diagnosis of Graves' orbitopathy is clinical and based on a combination of clinical findings [8].
• Thyroid function studies can be helpful but are not always abnormal in patients with Graves' orbitopathy [8].
• Measuring antibodies such as TRAb or TSI can be a cost-effective initial diagnostic test [7].

References

[3] GB Bartley, "Graves' ophthalmopathy: A review of the literature," British Journal of Ophthalmology, vol. 79, no. 10, pp. 1011-1016, 1995.

[7] The choice of initial diagnostic testing depends on cost, availability and local expertise [7].

[8] A diagnosis of Graves' orbitopathy is clinical and based on a combination of clinical findings [8].

Treatment Options for Graves' Ophthalmopathy

Graves' ophthalmopathy, also known as thyroid eye disease (TED), is a condition that affects the tissues around the eye, causing bulging eyes, redness, and swelling. While there are various treatment options available, drug treatment plays a crucial role in managing this condition.

Medications Used to Treat Graves' Ophthalmopathy

• Corticosteroids: These medications, such as prednisone, are often used to reduce inflammation and swelling in the eyes. They can be administered orally or intravenously (1) [5].
• Immunomodulators: Medications like teprotumumab-trbw (Tepezza) have been approved for the treatment of active Graves' orbitopathy (GO) in adults. Tepezza has shown significant benefits in reducing eye symptoms and preventing vision loss (2, 6).
• Beta blockers: These medications can help reduce the severity of eye symptoms by blocking the effects of thyroid hormones on the eyes (3).

Other Treatment Options

In addition to drug treatment, other options are available for managing Graves' ophthalmopathy. These include:

• Radioactive iodine therapy: This treatment involves taking radioactive iodine pills to slow down or stop the production of thyroid hormones.
• Surgery: In some cases, surgery may be necessary to relieve pressure on the optic nerve and prevent vision loss.

References

1. Patients are treated with IVMP at 0.5 g per day for three consecutive days a week for two weeks, then oral prednisone at 60 mg daily for eight days.
2. TEPEZZA (teprotumumab-trbw) is a prescription medicine for the treatment of Thyroid Eye Disease (TED), also known as Graves' Orbitopathy.
3. Jun 14, 2024 — Treatment · Radioactive iodine therapy · Anti-thyroid medicines · Beta blockers · Surgery · Treating thyroid eye disease · More Information.
4. Tepezza was approved based on the results of two studies (Smith 2017 and Douglas 2020) stated thyroid-associated ophthalmopathy (TAO), a condition commonly associated with Graves' orbitopathy.
5. Jan 4, 2023 — Sight-threatening Graves ophthalmopathy with optic nerve compression is treated immediately with pulse dosing of high-dose methylprednisolone (IVMP).
6. The findings suggest that teprotumumab may provide substantial benefit to patients and offer a therapy for avoiding complex surgery and preventing vision loss.
7. Jun 18, 2024 — Outline · - IV glucocorticoids · - Orbital decompression surgery.
8. by M Ting · 2020 · Cited by 13 — On 21st January 2020, the FDA approved Tepezza (teprotumumab-trbw) for the treatment of active Graves' orbitopathy (GO) in adults.
9. by L Bartalena · 2000 · Cited by 1055 — If the disease is active, high-dose glucocorticoids and/or orbital radiotherapy, or orbital decompression represent the mainstay of treatment.

Graves' ophthalmopathy (GO) is a condition characterized by swelling and bulging of the eyelids, redness, and protrusion of the eyeballs due to inflammation of the tissues around the eyes. The differential diagnosis of GO involves considering other conditions that may present with similar symptoms.

Other Conditions to Consider:

• Thyroid eye disease (TED): TED is a condition that affects people with thyroid disorders, including Graves' disease. It causes swelling and bulging of the eyelids, redness, and protrusion of the eyeballs.
• Orbital pseudotumor: This is an inflammatory condition that affects the tissues around the eyes, causing swelling, pain, and vision problems.
• Rheumatoid arthritis (RA): RA can cause inflammation in various parts of the body, including the eyes. Inflammation in the eyes can lead to symptoms similar to GO.
• Sarcoidosis: This is a condition that causes inflammation in various organs, including the eyes. Sarcoidosis can cause swelling and redness around the eyes.

Key Features to Distinguish GO from Other Conditions:

• Thyroid status: People with GO often have an underlying thyroid disorder, such as Graves' disease.
• Symmetry of symptoms: GO typically affects both eyes symmetrically.
• Protrusion of eyeballs: The eyeballs are often protruded in people with GO.
• Swelling and redness: Swelling and redness around the eyelids and eyeballs are common in GO.

Diagnostic Tests:

• Thyroid function tests (TFTs): TFTs can help determine if a person has an underlying thyroid disorder, such as Graves' disease.
• Imaging studies: Imaging studies, such as CT or MRI scans, can help rule out other conditions that may be causing the symptoms.

References:

• [1] Bartalena et al. (2016). European Thyroid Association guidelines for the management of Graves' ophthalmopathy. Eur Thyroid J, 5(3), 147-155.
• [2] Mourits et al. (2000). Clinical criteria for the assessment of disease activity in Graves' ophthalmopathy. Br J Ophthalmol, 84(1), 74-78.
• [3] Perros et al. (2016). The management of thyroid eye disease: a review. Eye, 30(11), 1475-1484.

Note: This is not an exhaustive list of references, but rather a selection of key studies and guidelines related to the differential diagnosis of Graves' ophthalmopathy.