James C. Orcutt, M.D., Ph.D.
Elevated eye pressure is extremely common in patients with Graves’ eye disease. However, this does not necessarily mean that glaucoma is also common in Graves’ disease.
Glaucoma is elevation of pressure within the eye which eventually leads to diminution of side vision and damage to the sight nerve which can be seen by the ophthalmologist when he looks in the eye. Elevation of eye pressure alone is therefore not sufficient to make a diagnosis of glaucoma.
On the other hand, eye pressure is commonly elevated in patients with Graves’ disease because of the swelling to the eye muscles and tissues behind the eye. When a patient with Graves’ disease moves their eyes, the stiff muscles behind the eye squeeze against the eye, causing the eye pressure to increase. Fortunately, when most patients with Graves disease look downward, the eye pressure is totally normal. Therefore, most patients with Graves’ disease have only an eye movement elevation of their eye pressure. If the eye is held in this position in which the pressure is elevated, the pressure will rapidly return to a normal level. In addition, most patients with these stiff eye muscles tend to hold their eyes in downward position with their chin slightly forward. So the pressure increase of Graves’ disease is temporary and does not lead to either side vision loss or to damage to the sight nerve.
While it is certainly true that there must be a rare patient who has true glaucoma and Graves’ disease, this is actually very uncommon. The elevated eye pressure can lead to a misdiagnosis of glaucoma in many patients with Graves’ disease. A worrisome problem which this creates is that a misdiagnosis of glaucoma leads to inappropriate treatment if a patient should be losing vision from their Graves’ disease and not glaucoma. Periodic visits to your ophthalmologist should be able to guard against a misdiagnosis.
Used with permission of the author:
James C. Orcutt, M.D., Ph.D., Associate Professor of Ophthalmology, University of Washington (1991)
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