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Denver Graves patients want to know: What caused my eyes to bulge?

Thyroid Eye Disease or Graves patients commonly have eye bulging or proptosis. This is where patients with Graves feel that their eyes became bulgy or “bug eyed”. There are reasons why this happens in Graves eye disease. As a Graves eye disease specialist, I treat patients for bulging eyes from Graves.

Graves disease is an autoimmune condition that causes an increase in inflammation in the eye muscles and fat. Specifically, graves disease increases glycosoaminoglycans and hyaluronic acid in the orbit. Glycosoaminoglycans are chemicals that attract water. Water accumulates in the orbit and eye muscles, causing the eye muscles to swell. This also decreases their function. Additionally Graves disease causes stimulation of the expansion or production of fat in the orbit.

Think of the eye socket as a box where the eye , eye muscles, nerves and fat exist. If there is expansion of the eye muscles and fat in this closed box as a result the eye gets pushed forward. This causes the eye to appear bulgy or pushed forward. We have instruments (such as a Hertel exophthalmometer) to look at the bulging of the eye. Imaging using a Cat Scan or MRI can evaluate the eye bulging by looking at the muscle swelling or increased fat.

Normal Eye Socket
Graves Eye Disease Eye Socket

The treatment for eye bulging are several. IV steroids can be given. Finally an orbital decompression can be done. Orbital decompression is essentially shrinking the contents of the eye socket. This is done by either breaking the bones of the eye socket to make the eye contents sink back into the eye socket. Secondarily, the fat in the eye socket can be removed (as much as safely possible). This also has the same effect by removing contents from the eye socket to make the eye sink back further in the eye socket. Sometimes orbital decompression has to be done because the muscle and fat is putting so much pressure that the optic nerve (nerve that supplies the eye) starts to get compressed or damaged.

This risks of orbital decompression are not few. Vision loss and worsening double vision are two big risks. Specifically 1/3 of patients can have worsening double vision after orbital decompression and may need eye alignment surgery. These are the two most serious risks but like any surgery bleeding, scarring and infection are other risks that are common to any surgery.

If you have Graves eye disease in Colorado and need an evaluation, call our office for an appointment. As Graves or Thyroid Eye disease specialists, that is what we do, day in and day out. Hope this helps any patient who has graves disease in Denver, Colorado or elsewhere.

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