Graves’ disease is caused by a malfunction in the body’s disease-fighting immune system, although the exact reason is still unknown.
In Graves’ disease — for reasons that aren’t well understood — the body produces an antibody to one part of the cells in the thyroid gland, a hormone-producing gland in the neck. This can cause a number of physical reactions, including weight loss, rapid heart rate, sweating, and changes to bone, skin, and nails.
The overactive thyroid targets the area surrounding the eyes and may cause inflammation, redness, achiness, pink eye, eyelid retraction and bulging eyes. In extreme cases of Graves’ eye disease, swollen eye muscles may put extreme pressure on the optic nerve, leading to double vision or vision loss.
Graves’ eye disease often appears at the same time as hyperthyroidism or several months later. But signs and symptoms of this disease may appear years before or after the onset of hyperthyroidism. Graves’ eye disease can also occur even if there’s no hyperthyroidism.
An eye care professional can determine the presence of Graves’ eye disease through a thyroid function test after observing common symptoms.

  • Eye inflammation
  • Eye redness
  • Bulging eyes
  • Eye dryness
  • Eye weakness
  • Eye sensitivity
  • Eyelid retraction

Symptoms of Graves’ eye disease may clear without intervention. Many patients will need to continue treatment to regulate the overactive thyroid, and continue with symptom-based treatments. These treatments may include:

  • Radioiodine therapy: a treatment in which radioiodine is ingested to kill overactive thyroid cells
  • Anti-thyroid medications: used to treat the symptoms of an overactive thyroid, as well as to slow or stop the production of antibodies
  • Thyroid surgery: used for the removal of the overactive thyroid gland, accompanied by hormone replacement therapy

Symptom-based treatments:

  • Medications: includes topical lubrications such as artificial tears, and other treatments to relieve eye inflammation and lubricate bulging eyes.
  • Surgery: surgical options are available for several symptoms of Graves’ eye disease, including procedures to remove portions of the orbital region to make room for swollen tissue, realign weakened eyes to prevent double vision, and relieve discomfort and appearance issues associated with retracted eyelids.

Sources: Bausch & Lomb
Mayo Clinic
National Health Institute