Graves disease is an autoimmune disorder where the thyroid pumps out too much thyroid hormone. Graves’ is the most common cause for hyperthyroidism and is more common with women. Graves’ can cause ocular problems such as eyelid retraction (giving people a wide-eyed appearance) and swelling of the eye muscles located behind the eye. This swelling causes the eye to protrude forward – a condition called proptosis or exophthalmos. Protrusion can cause extreme dry eye and exposure problems if the eyelids don’t close completely while sleeping. Double vision is common secondary to the eye muscle involvement. If bad enough, muscle swelling can push on the optic nerve behind the eye and create neurologic vision loss. Treatment is geared toward normalizing thyroid levels and lubricating the eye. If double vision is constant, strabismus surgery can be considered. Decompression surgery (usually with an ENT doctor or an oculoplastic surgeon) is sometimes performed to give the eye more room inside the eye socket.