Swollen eyeball: Causes, symptoms, and treatments
What Is Thyroid Eye Disease, And When Does It Require Surgery?
Thyroid eye disease (TED), also known as Graves' eye disease, usually stems from an autoimmune condition that starts when immune cells attack the thyroid gland, a tiny butterfly-shaped gland at the front of the neck.
Usually, the thyroid goes unnoticed, doing its job manufacturing the hormones that regulate the body's metabolism. But when immune cells invade, the tiny gland responds by enlarging and secreting an excess amount of thyroid hormone. This results in increased metabolism, causing symptoms such as a fast heartbeat, high blood pressure, palpitations, heavy sweating, irritability, fatigue, and weight and hair loss.
"When the thyroid goes into overdrive, the immune system may also attack the tissues around the eyes," explains Robert Kersten, MD, chief of the John A. Moran Eye Center's Oculoplastic Division and part of University of Utah Health's Thyroid Eye Disease (UTED) program.
Thyroid Eye Disease SymptomsTED symptoms can vary, and they may come and go, but Kersten lists these as a few of the most common:
"Fortunately, we can treat all of these symptoms, and some new drugs are helping to make a real difference for some patients," Kersten says. "But the treatments can vary as much as the symptoms. Because TED diagnoses and symptoms tend toward the complex, patients need to work closely with their ophthalmologists and thyroid specialists to find the best customized treatments."
"About half of the patients with Graves eye disease will develop a disease called Graves' orbitopathy, an eye socket disorder," Kersten says. "And some of this group will require surgery."
Because the eye socket stays the same, the enlarged eye muscles may not move properly. This can cause double vision. Increased pressure in the eye socket can also damage the optic nerve, causing loss of eyesight.
At this point, a surgery called endonasal endoscopic orbital decompression, done through the nose without external incisions through the skin, is often the solution to relieve the pressure.
Kersten works with UTED to take a team approach in customizing each case and consulting with the university's fellowship-trained physicians in endocrinology, sinus and skull base surgery, oculoplastics, and neuro-ophthalmology. Many TED patients need a team with both medical and surgical expertise.
How Graves' Disease Affects The Eyes
Graves' disease can cause the immune system to damage the tissues and muscles around the eyes. This can cause symptoms such as inflammation and bulging.
Graves' disease is an autoimmune disorder that causes your thyroid gland to produce more hormones than it should. An overactive thyroid is called hyperthyroidism.
Sometimes, the immune system attacks tissues and muscles around the eyes. This condition is called thyroid eye disease (TED) or Graves' ophthalmopathy (GO). Inflammation causes the eyes to feel gritty, dry, and irritated.
This condition can also make your eyes bulge out. This bulging is usually worse in one eye compared with the other.
Other potential symptoms of Graves' disease include:
Graves' eye disease affects around 40% of people who have Graves' disease. It can also occur in people who don't have Graves' disease or be the first symptom for those who haven't yet received a diagnosis.
Early symptoms of GO generally start around the same time as other symptoms of Graves' disease, but eye problems develop first in about 25-50% of people with the disease. Rarely does GO develop long after treatment for Graves' disease.
Symptoms of GO may include:
In severe cases, you might also have:
Rarely, GO can lead to vision loss.
Graves' eye disease often affects both eyes. Up to 14% of the time, only one eye is involved.
For people with GO, there's a period of active inflammation around the eyes during which symptoms worsen. This can last up to 6 months. Then, there's an inactive phase in which symptoms stabilize or start to improve.
There's no connection between your eye symptoms and the severity of hyperthyroidism.
The exact cause of GO isn't clear, but it may be a combination of genetic and environmental factors.
The inflammation around the eye is due to an autoimmune response. With GO, the same abnormal immune response that triggers the thyroid gland in Graves' disease affects the muscles and soft tissues around the eye. This leads your body to produce an inflammatory response.
Graves' eye disease usually occurs along with hyperthyroidism, but not always. It can also happen when your thyroid isn't currently overactive.
Risk factors for GO include:
Females have a higher risk of developing GO than males, as they have a higher risk of autoimmune disease.
There's no way to prevent Graves' disease or Graves' eye disease. But if you have Graves' disease and you smoke, you're more likely to develop eye disease than people who don't smoke. Plus, eye disease tends to be more severe for those who smoke.
If you have Graves' disease, a doctor can make a diagnosis of GO after an eye exam.
A specialized doctor called an ophthalmologist typically helps manage GO, while a primary care doctor or endocrinologist typically manages hormone treatment for Graves' disease.
If you don't already have a diagnosis of Graves' disease, a doctor will likely examine your eyes and your neck to see whether your thyroid is enlarged.
They may order a blood test to check your thyroid-stimulating hormone (TSH) levels. TSH, a hormone produced in the pituitary gland, stimulates the thyroid to produce hormones. If you have Graves' disease, your TSH level may be low, but you'll typically have high levels of thyroid hormones.
Blood tests can also check for Graves' antibodies. This test isn't needed to make the diagnosis, but it may be done anyway. A doctor can start looking for another diagnosis if it turns out to be negative.
A doctor may also order imaging tests such as ultrasound, CT scan, or MRI for a detailed look at the thyroid gland.
A doctor may also order a radioactive iodine uptake. For this procedure, you'll take some radioactive iodine and allow your body to absorb it. Later, a special scanning camera can help determine how well your thyroid takes in iodine. This helps inform the diagnosis of Graves' disease.
Treating Graves' disease involves specific therapies to keep hormone levels within the normal range. Graves' eye disease requires treatment since treating Graves' disease doesn't always help with eye symptoms.
One approved medication for active thyroid eye disease is teprotumumab (Tepezza). Research shows it can reduce symptoms of GO, including eye bulging and double vision.
You can also try a few things on your own to ease GO symptoms, including:
Be sure to tell the ophthalmologist if nothing is working and you continue to have double vision, decreased vision, or other problems.
Some surgical interventions for GO can help, too. These include:
These procedures can help improve vision or the appearance of your eyes.
Rarely radiation therapy, called orbital radiotherapy, is used to reduce swelling in the muscles and tissues around the eyes. This is done over several days.
Other treatments may be more appropriate if your eye symptoms are unrelated to Graves' disease.
What are the first signs of Graves' eye disease?The first signs of Graves' eye disease can include inflammation, irritation, and puffiness.
Can Graves' eye disease be cured?While there is no cure for Graves' eye disease, treatment can help the disease stabilize or improve.
What foods should be avoided with thyroid eye disease?If you have thyroid eye disease or thyroid disease, you may need to avoid foods and supplements containing iodine. These can include:
Treating thyroid eye disease may help improve your symptoms. You can also try at-home remedies, such as applying a cold compress, using lubricating eye drops, and sleeping with your head elevated.
GO is a medical condition with ups and downs. Treatment options may change depending on the severity of your symptoms. In general, GO can be successfully treated with medication, home remedies, or surgery.
Because the disease is so dynamic, a doctor likely won't recommend surgery unless there's a vision emergency.
Symptoms can improve even without treatment, but treatment can help lower the chance of permanent eye damage from inflammation. With proper treatment, symptoms of GO usually stabilize. They may start to improve immediately or remain stable for a year or two before they improve.
While the symptoms can be frustrating and disruptive to your everyday life, it's very rare for GO to cause blindness, especially with proper treatment.
If you receive a diagnosis of Graves' disease, consider finding an ophthalmologist to screen you for eye problems and let a doctor know right away if you have any bothersome eye symptoms.
How Your Eyes Can Reveal Signs Of Cardiovascular Disease
Normal Retina.
Multidisciplinary Digital Publishing Institute (MDPI)This story is part of a series on the current progression in Regenerative Medicine. This piece is part of a series dedicated to the eye and improvements in restoring vision.
In 1999, I defined regenerative medicine as the collection of interventions that restore tissues and organs damaged by disease, injured by trauma, or worn by time to normal function. I include a full spectrum of chemical, gene, and protein-based medicines, cell-based therapies, and biomechanical interventions that achieve that goal.
Our eyes are one of the most remarkable organs in our body, serving as the windows to our souls and providing a wealth of information about our overall health. Recent scientific research has demonstrated that the eyes can reveal signs of various diseases, including cardiovascular disease.
Cardiovascular disease is a severe and prevalent health condition worldwide that can lead to death if not detected early. Fortunately, our eyes can provide valuable insights into the disease. By closely examining the eyes, doctors can identify several indications of cardiovascular disease, and early detection can lead to timely intervention and better patient outcomes.
An Interbody LinkThe human eyes are an incredible organ linked to different body parts through a complex network of veins, arteries, and nerves. These connections allow the eyes to provide valuable information about the body's overall health. For instance, the eyes can display symptoms of diseases affecting other parts of the body, making them an essential tool for diagnosis.
The eyes are connected to various body organs, such as the skin, joints, and gastrointestinal system. Through this interbody link, the eyes can show signs of diseases such as diabetes, high blood pressure, and cancer. For example, high blood pressure can cause changes to the blood vessels in the eyes, leading to blurry vision or even blindness. Similarly, diabetes can cause damage to the tiny blood vessels in the retina, leading to vision loss.
The Eyes as a Screening ToolWith advances in retinal imaging, it is now possible to detect diseases in other body parts by examining the eyes. This is because the eyes contain a wealth of information about the body's health. Retinal imaging can help to detect signs of diseases such as Alzheimer's, Parkinson's, and multiple sclerosis. It can also aid in early heart disease, stroke, and cancer detection.
Retinal imaging is an affordable and non-invasive method that captures accurate and detailed retina images - the thin layer of tissue at the back of the eye responsible for converting light into neural signals. These images can provide valuable information about the health of the eyes and the body.
Researchers are developing systems that can automatically scan retinal photos for signs of various diseases, including cardiovascular disease. Using machine learning algorithms, these systems can learn from vast datasets of retinal images with known disease outcomes and identify subtle patterns or abnormalities that may indicate disease.
Studies have shown that this approach has yielded promising results. If successful, it can significantly improve the efficiency and accuracy of retinal screening, leading to earlier disease detection and better patient outcomes, particularly in the case of cardiovascular diseases.
Seeing Your Heart HealthWhen it comes to the eyes, several signs may indicate the presence of cardiovascular disease. One of these symptoms is double vision or diplopia. This means a person sees two images of a single object instead of one. Double vision can occur in one or both eyes and be constant or intermittent. It may also be accompanied by other symptoms such as headaches, dizziness, and difficulty with balance and coordination.
Another indicator is a yellowish ring around the cornea, an arcus senilis. This ring is usually seen in older adults. Still, when present in younger people, it may suggest high cholesterol levels, which can increase the risk of heart disease.
A patient with hypertension
EyeNet Magazine by American Academy of OpthalmologyHigh blood pressure is another sign of cardiovascular disease, and it can cause damage to the blood vessels in the retina. This can result in changes such as narrowing or ballooning. Individuals with cholesterol deposits in or around their eyes are at an increased risk of stroke and heart attack. Moreover, high blood pressure can cause changes in the blood vessels in the retina, leading to the appearance of narrowed, thickened, or even ruptured blood vessels. These changes can be detected through an eye exam and may signal an increased risk of stroke or heart attack.
These diagnostic imaging scans showcase occlusions in arterial (2a) and venous (2b) systems, ... [+] represented by the black areas.
© American Academy of Ophthalmology 2023Retinal vein occlusion is an eye condition that affects the veins in the retina. This condition is often associated with vascular disease. It occurs when blood flow through the retinal veins is blocked, causing swelling and bleeding in the eye. Retinal vein occlusion is a severe manifestation of vascular disease. It can be an indicator of significant atherosclerosis in the body. Those with this condition are at a higher risk of developing other cardiovascular problems, such as heart attack or stroke.
It has been found that age-related macular degeneration (AMD), which is a common cause of vision loss for older adults, is linked to cardiovascular disease and stroke. A study by Mount Sinai revealed that patients with cardiovascular disease were three times more likely to suffer from a specific type of AMD, which indicates a close relationship between these two disorders.
Moreover, the appearance of small, yellowish deposits, called drusen, in the retina could also indicate cardiovascular disease. These deposits can cause impaired vision and are commonly seen in individuals with age-related macular degeneration, which has been associated with an increased risk of cardiovascular disease.
The Eye is a Diagnostic DreamIn summary, as the field of retinal imaging and artificial intelligence continues to advance, the eyes' diagnostic capabilities are expected to expand as a non-invasive and easily accessible tool for screening and early detection of a wide range of diseases, including cardiovascular diseases.
To learn more about the eye, read more stories at www.Williamhaseltine.Com
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