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What Is Thyroid Eye Disease?

Thyroid eye disease is a rare disease characterized by progressive inflammation and damage to tissues around the eyes, especially extraocular muscle, connective and fatty tissue. Thyroid eye disease is an autoimmune disorder that may occur in patients who already know they have thyroid disease. This article will cover the primary definition of thyroid eye disease, the symptoms and what treatments are available.


What is thyroid eye disease? 

Also known as TED (thyroid eye disease) or Graves' eye disease, thyroid eye disease is an autoimmune disorder involving an imbalance or recognition problem with your immune system. Most commonly, this happens as part of thyroid disease from an overactive thyroid gland, affecting the skin and eyes. This autoimmune disease causes inflammation and swelling, stimulating the production of muscle tissue and fat behind the eye. Up to one-half of people with Graves' disease develop these eye symptoms.


Stages of thyroid eye disease

There are two phases of thyroid eye disease. The first is the inflammatory phase which can last from six months to two years, while the second is the stable phase, during which the active inflammation is dormant. Following the inflammatory phase, many individuals are left with eye protrusion, eyelid retraction or double vision, which can be treated in various ways. If you believe you have thyroid eye disease, you must talk to your doctor immediately.


What does thyroid eye disease look like?



Thyroid eye disease symptoms can vary significantly from one person to another. For some individuals, symptoms can lead to pain, disfigurement, or threatened eyesight. For others, the disorder remains unchanged for many years but for others it can either worsen or slightly improve.


Initial symptoms can include:

  • Redness

  • Irritation

  • Discomfort of the eyes and eyelids

  • Dry eyes and pain when moving eyes.

  • Eyelid retraction (the upper eyelid is too high or lower eyelid too low, exposing your eye)

  • Eyes bulging (exophthalmos) or eyes protruding outwards (proptosis) causing a person to look as though they are constantly staring


Additional symptoms can include:

  • Blurred vision

  • Double vision (diplopia)

  • Misalignment of the eyes (strabismus)

  • Chronic bloody eyes

  • White area of eye inflammation

  • Constant watery eyes due to excess tears

  • Swelling around upper or lower eyelids

  • Difficulty looking at bright lights

  • Difficulty moving eyeballs


Progressive swelling can cause increased pressure within the eye socket, headaches and pain. In more severe cases, enlarged eye muscles can compress and cause damage to the optic nerve, which is the main nerve in the eye. As a result, this can progress to cause vision loss over time. Graves thyroid eye disease can also lead to scarring and tissue remodelling around the eyes after inflammation. This can change the eyes' cosmetic appearance and lead to constantly appearing tired. 


If you are experiencing these symptoms, you must seek medical advice from your doctor.


What causes thyroid eye disease?

The underlying process of why thyroid eye disease occurs is not fully understood. The immune system creates an abnormal antibody called thyroid-stimulating immunoglobulin. These abnormal antibodies can affect the cells surrounding your eyes, causing the symptoms associated with the disorder. However, researchers believe people with thyroid eye disease carry the genes for the disorder, activated due to environmental factors. Those who are more at risk of developing the condition include those who:


  • Smoke

  • Have undergone radioactive iodine therapy

  • Have other health conditions that affect the immune system, e.g. diabetes type 1 or rheumatoid arthritis


Thyroid eye disease treatment

Within this section, we have included the various treatments available for thyroid eye disease. However, we recommend you consult your local optician or doctor for professional advice. The below treatments are some of the options you may be provided with from your doctor after diagnosis.


Treating thyroid eye disease requires the coordinated efforts of a team of specialists (ophthalmologists). In recent years, Tepezza® was the first approved drug to help treat thyroid eye disease. Affected individuals have shown significant improvement in double vision and quality of life after taking this thyroid eye disease medication. Another option is to take prescribed steroids (such as hydrocortisone or prednisone) to help reduce the swelling of the eyes from your doctor.


Surgery may be an option for individuals with moderate-to-severe stages of the disease. Surgery tends to be avoided until after the active phase has ended, once inflammation and swelling have reduced. However, surgery may be necessary during the active stage if vision is at risk from the disease. 


Orbital Decompression Surgery

The swollen tissues around the eye can compress your main optic nerve. As a result, colour vision becomes abnormal, lights may seem dimmer and vision sharpness decreases. Orbital decompression surgery can help improve your vision by making your eye socket larger or removing excess tissue caused by TED. The surgery can help restore comfort and appearance by reducing the bulging of the eyes. This surgery is typically only given to individuals at risk of vision loss due to pressure on the optic nerve.


Supportive Measures

Some individuals with milder thyroid eye disease can be treated with supportive measures, like dark sunglasses to treat sensitivity to light, artificial tears from your local pharmacy and prisms attached to glasses. When you have thyroid eye disease, your eyes are more sensitive to sunlight and UV rays, so wearing sunglasses helps protect them from the sun and wind.

People with the moderate-to-severe disease may receive corticosteroids, drugs that reduce inflammation and swelling but do not affect diplopia and proptosis. Prednisone is often a common corticosteroid used to treat individuals with thyroid eye disease.


How to reduce swelling from thyroid eye disease?

As well as the above options to treat thyroid eye disease, there are other ways to help reduce swelling. You can try applying cool compresses to your eyes, providing additional moisture and cooling. Try elevating your head when lying down to help reduce swelling and relieve pressure on your eyes. We recommend contacting your doctor if you are experiencing swelling so that you can be given professional advice and prescribed the correct treatment.


Is thyroid eye disease permanent?

Thyroid eye disease is a temporary condition that will eventually fade in time. However, the inflamed period can last from months to years and have a range of impacts on your physical health. 



Thyroid eye disease is a treatable problem that usually develops in people with an overactive thyroid caused by Graves' disease. If you believe you have thyroid eye disease, contact your doctor to receive the best advice on maintaining your eye health.