From the Guidelines
The most effective treatment for dry eyes due to exophthalmos in Graves' disease is the use of ocular lubricants, which are almost always needed to combat exposure related to eyelid retraction and proptosis, as recommended in the 2020 adult strabismus preferred practice pattern 1. To manage dry eyes in patients with Graves' disease, the following approaches can be considered:
- Ocular lubricants are essential to reduce exposure and prevent further irritation, with punctal plugs also being a useful option to conserve tears 1.
- Patients should be advised to cease smoking to reduce inflammation and promote healing.
- In cases of selenium deficiency, selenium supplementation may help reduce some inflammatory symptoms, although it does not impact the control of hyperthyroidism in populations that are not selenium deficient 1.
- Treatment with teprotumumab, a human monoclonal antibody inhibitor of IGF-IR, has been shown to attenuate the actions of IGF-I, thyrotropin, thyroid-stimulating immunoglobulins, and immunoglobulins in patients with Graves’ disease, reducing proptosis and the clinical activity score of disease in many with active disease 1.
- For severe cases, orbital decompression, high-dose steroids, or radiation treatment may be necessary to address proptosis or optic neuropathy, and strabismus repair should be delayed until after decompression to avoid exacerbating the condition 1. The primary goal of these treatments is to alleviate dry eye symptoms, prevent complications, and improve the patient's quality of life, while also addressing the underlying Graves' disease and its associated exophthalmos.
From the Research
Treatment for Dry Eyes due to Exophthalmos in Patients with Graves' Disease
- The treatment for dry eyes due to exophthalmos (bulging eyes) in patients with Graves' disease typically involves addressing the underlying condition of Graves' ophthalmopathy 2, 3, 4, 5, 6.
- According to a study published in 1984, patients with Graves' disease who were stable with symptomatic treatment were observed and followed, while those with progressive soft tissue inflammatory signs were treated with oral steroids or radiotherapy 2.
- Another study published in 2012 found that intravenous pulse doses of corticosteroids were effective in treating Graves' ophthalmopathy, with 23.81% of patients showing recovery and 47.62% showing partial amelioration after 6 months of treatment 3.
- Radiotherapy has also been shown to be effective in treating acute Graves orbitopathy, with significant improvement in subjective and objective signs of orbital congestion and relief of compressive optic neuropathy 4.
- High-dose intravenous corticosteroid therapy has been compared to oral corticosteroid therapy for Graves' ophthalmopathy, with both treatments showing significant improvement in signs and symptoms of orbital inflammation 5.
- A study published in 1989 compared the efficacy of prednisone and cyclosporine in the treatment of severe Graves' ophthalmopathy, finding that prednisone was more effective than cyclosporine, but combination therapy with both drugs was also effective in patients who did not respond to either drug alone 6.
Management of Dry Eyes
- Dry eyes can be managed with artificial tears and other lubricating eye drops to help relieve symptoms 2, 3, 4, 5, 6.
- In some cases, surgical procedures such as tarsorrhaphy or lateral canthoplasty may be necessary to help manage dry eyes and other symptoms of Graves' ophthalmopathy 2.
- It is essential to work with an ophthalmologist and endocrinologist to develop a comprehensive treatment plan for managing dry eyes and other symptoms of Graves' disease 2, 3, 4, 5, 6.