• Chris Thiagarajah MD

Vision loss and Graves Disease: Cause and Treatment

Vision loss and Graves Disease: Cause and Treatment

Graves disease is a disease characterized by inflammation in the orbit or eye socket with swelling. Most often, patients associate graves disease with bulging eyes and double vision but one of the more serious and lesser known complications from Graves disease is vision loss. I regularly treat patients for graves disease in Denver and as a Graves eye disease doctor it is important to understand the cause and treatment of vision loss in Graves so it can be picked up quickly by the patient. There are subtle signs that are important to know as a patient so you will know when to see your Graves disease specialist.

What causes vision loss in Graves disease?

Vision loss from Graves disease is caused by pressure on the optic nerve in the orbit. As discussed in previous articles, there is an increase in fat and muscle in the orbit of patients with Graves. This causes pressure on the optic nerve or nerve that transmits information from the eye to the brain. If it is compressed, it loses function and the patient often has trouble seeing and can go blind. This is referred to as Graves optic neuropathy.

What are the signs of vision loss in Graves disease?

There are several symptoms for patients that may point to an optic neuropathy in Graves disease.

Decreased color vision – Having trouble with colors especially reds. In an eye with an optic neuropathy reds may appear orange or brown

Decreased visual field – This is decreased peripheral vision

Decreased clarity of vision – This is characterized by decreased vision that one CANNOT blink out of. Graves patients often have dry eyes and that can cause blurry vision. Dry eye blurry vision often improves or changes if the patient blinks or lubricates the eye. In graves disease, blinking will not change the clarity of vision in the eye.

What are the tests the doctors office does if I am having vision loss in Graves Eye Disease?

There are several tests that are critical to evaluate vision loss at the disposal of eye doctors. They are:

Color plates – tests for damage to the optic nerve via color vision

Ocular Computerized Tomography – looks at swelling of the optic nerve

Visual Field – looks at areas patients are having trouble seeing, even if they don’t realize it

What are the treatments for Graves disease vision loss?

There are two treatments for vision loss in Graves disease. The first is IV steroids which are given in the hospital or outpatient. The second is orbital decompression to release pressure on the optic nerve. The EUGOGO trial in Europe showed that IV steroids should be used first for 2 weeks to attempt to bring the vision down before surgery is attempted.

Hopefully if you are a patient with Graves disease in Colorado or the United States, it is good to understand this component of the disease. Less than 5% of patients with graves experience vision loss and it is important to understand the causes,testing and treatment of this complication of the disease.