Suspected to be related to auto reactive T lymphocytes reacting with one or more antigens shared by the thyroid and orbit.
T lymphocytes reacting with the antigens causes secretion of cytokines that stimulate orbital fibroblasts, expansion of adipose tissue and secretion of hydrophilic glycosaminoglycans from fibroblasts.
Graves’ ophthalmopathy can be divided into two clinical phases: the inflammatory stage and the fibrotic stage.
The inflammatory stage is marked by edema and deposition of glycosaminoglycan in the extraocular muscles.
The clinical manifestations of the inflammatory stage are orbital swelling, stare, diplopia, periorbital edema, and, at times, pain.
Graves’ ophthalmopathy does not always improve with treatment for Graves’ disease, as symptoms of Graves’ ophthalmopathy may even worsen for 3 to 6 months.
After that, the signs and symptoms usually stabilize for a year or so and then begin to get better, often on their own.
Mild symptoms may be managed by using artificial tears during the day and lubricating gels at night.
With more severe symptoms treatments may include: corticosteroids, orbital decompression surgery, orbital radiotherapy, and nonpharmacologic therapies.
Corticosteroids may reduce swelling behind the eyeballs.
Orbital decompression surgery is a procedure that removes the bone between the eye socket and sinuses, allowing room for the eye to move back to their original position.
Orbital decompression surgery is employed if pressure on the optic nerve threatens the loss of vision.
Orbital radiotherapy may be used to destroy some of the tissue behind the eyes.
Applying cool compresses to the eyes, may be soothing.
Wear glasses sunglasses to lessen sensitivity to ultraviolet (UV) rays and bright light, and lubricating eye drops may relieve the dry, scratchy sensation on the surface of the eyes may help.
Elevating the head of the bed keeps the head higher than the rest of the body lessens fluid accumulation in the head and may relieve the pressure on the eyes.
Smoking worsens Graves’ ophthalmopathy.