Published in Systemic Disease

Autoimmune Endocrine Disease and the Eye Study Guide

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2 min read
The eye is frequently involved in numerous autoimmune and endocrine disorders. In part three of this four-part study guide, we discuss Graves' disease.
Autoimmune Endocrine Disease and the Eye Study Guide


Autoimmune diseases have a variety of systemic manifestations; the eye is frequently involved in numerous autoimmune and rheumatologic disorders. Ocular manifestations are frequently nonspecific and different diseases may affect different parts of the eye, but early recognition of symptoms can help avoid or delay both systemic and ocular sequelae.
The most common autoimmune diseases that affect the eyes can be separated into four categories:
  1. Rheumatologic
  2. Dermatologic
  3. Endocrine
  4. Vascular
This is part three of a four-part series in which we discuss Graves’ disease, an autoimmune endocrine disease that affects the eye.

Graves’ disease1-10

Graves’ disease - epidemiology

  • Eye manifestations
    • All cases of Graves Ophthalmopathy
      • 9-15 per 10,000
    • Secondary to Graves Hyperthyroidism
      • 25%

Graves’ disease - mechanism

  • Thyroid-stimulating hormone receptor antibodies & active T-cells activate retroocular fibroblast & adipocytes receptors 🡪
    • Retro-orbital inflammation
    • Fibroblast proliferation
    • Accumulation of hydrophilic glycosaminoglycans

Graves’ disease -risk factors

  • Genetics
  • Sex (women > men)
  • Smoking (OR: 2.22)
  • Radioiodine therapy

Graves’ disease - presentation

  • Asymptomatic
  • Exophthalmos
  • Proptosis and choroidal folds
  • Periorbital edema
  • Feeling of pressure behind eye
  • Gritty/foreign body sensation
  • Excessive tearing
  • Discomfort/pain
  • Blurry vision
  • Diplopia
  • Color vision desaturation
  • ↓ Vision

Graves’ disease - diagnosis

  • Labs (Grave’s Hyperthyroidism)
    • ↓ TSH
    • ↑ Free T3, T4
    • + TSH receptor antibodies
  • Imaging
    • Non-contrast CT
      • Baseline image of orbits
      • Risk of optic nerve compression by extraocular muscles
      • Measurement of
        • Proptosis
        • Retroocular fat accumulation

Disease Activity

Assessment of Graves’ Orbitopathy: Clinical Activity Score

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Maxwell A. Levi
About Maxwell A. Levi

Maxwell A. Levi is a 3rd year Medical Student with a passion for ophthalmology at Rowan in NJ.

Maxwell A. Levi
Alanna Nattis, DO, FAAO
About Alanna Nattis, DO, FAAO

Dr. Alanna Nattis is a cornea, cataract and refractive surgeon, as well as the Director of Clinical Research at SightMD. She is an Ophthalmology Editor for Eyes On Eyecare, and serves as an associate professor in ophthalmology and surgery at NYIT-College of Osteopathic Medicine. She completed a prestigious Ophthalmology residency at New York Medical College and gained vast experience with ophthalmic pathology in her training at both Westchester County Medical Center and Metropolitan Hospital Center in Manhattan.

Following her residency, she was chosen to be a cornea/refractive surgical fellow by one of the most sought after sub-specialty ophthalmic fellowships in the country, training with world-renowned eye surgeons Dr. Henry Perry and Dr. Eric Donnenfeld. During residency and fellowship, Dr. Nattis published over 15 articles in peer-reviewed journals, wrote 2 book chapters in ophthalmic textbooks, and has co-authored a landmark Ophthalmology textbook describing every type of eye surgical procedure performed, designed to help guide and teach surgical techniques to Ophthalmology residents and fellows. Additionally, she has been chosen to present over 20 research papers and posters at several national Ophthalmology conferences. In addition to her academic accomplishments, she is an expert in femtosecond laser cataract surgery, corneal refractive surgery including LASIK, PRK, laser resurfacing of the cornea, corneal crosslinking for keratoconus, corneal transplantation, and diagnosing and treating unusual corneal pathology. Dr. Nattis believes that communication and the physician-patient relationship are key when treating patients.

Alanna Nattis, DO, FAAO
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