Thyroid Eye Disease: Symptoms, Treatment and More

Thyroid eye disease (TED) is a rare autoimmune condition. The immune system attacks cells in the muscles and fatty tissues around the eyes.

TED is linked to existing thyroid problems but is considered a separate disease and not a direct complication of any thyroid condition.

Although it often abates after a few months, the condition has no cure, and long-term vision damage can result from it.

What Is Thyroid Eye Disease?

Thyroid eye disease (TED) is a rare autoimmune condition in which the body’s immune system attacks the cells in the muscles and fatty tissues around the eyes. It is also sometimes called thyroid associated orbitopathy or Graves’ ophthalmopathy. 

Thyroid eye disease is linked to preexisting thyroid conditions, but it is not a complication of thyroid disease. It often stabilizes after a few months and never gets worse. The condition can be treated by managing its symptoms and living a healthy lifestyle. If the condition becomes severe, aggressive treatments like radiation or surgery may be needed to keep it under control. 

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Symptoms

Symptoms of thyroid eye disease include:

• Red eyes 
• Dry eyes
• Watery eyes
• A gritty sensation in the eyes
• Sensitivity to light
• Puffiness around the eyes
• Difficulty closing the eyes
• Retracted eyelids
• Bulging eyes
• As the disease progresses, you may also experience:
• Increased pressure in the eye sockets
• Pressure headaches that get worse with eye movement
• Protruding eyes that make it look like you are constantly staring
• Double vision
• Partial or full vision loss

Causes

Thyroid eye disease is an autoimmune disease caused by an abnormal reaction in a person’s immune system.

This reaction is intended to target the thyroid receptors, but it is instead picked up by the muscles and fatty tissues around the eyes. This causes those tissues to swell and pressure to build behind the eyes.

If the effect continues for long enough, it may begin to push the eyes forward out of their sockets. This effect creates the distinctive look that patients with thyroid eye disease are known for. 

Thyroid eye disease is linked to existing thyroid problems, but it is considered a separate disease and not a direct complication of any thyroid condition. It can also occur in people without an existing thyroid condition, though this is rare. 

Risk Factors

Some people are at greater risk of developing thyroid eye disease than others, including:

• Women
• Middle-aged people
• Smokers and people with significant exposure to second-hand smoke
• People who have had radioactive iodine treatment for thyroid problems
• People with uncontrolled thyroid disease
• People who experience significant amounts of chronic stress

Related Disorders

There are many other disorders that can produce symptoms similar to those of thyroid eye disease. These include:

• Orbital cellulitis (a bacterial skin infection around the eye socket)
• Orbital myositis (inflammation of the muscles in the eye socket)
• Myasthenia gravis (a neuromuscular disorder that can lead to eye muscle weakness and drooping eyelids)
• Severe obesity
• Cushing’s syndrome (an endocrine disorder caused by elevated levels of cortisol)

Some less serious conditions may also produce symptoms similar to those of thyroid eye disease. These include:

• Hay fever
• Allergies
• Conjunctivitis

If your symptoms are due to one of these conditions, they will abate quickly when the condition subsides. 

Always consult your doctor about any new symptoms you experience, even if you think they are related to a mild condition. Early treatment makes a significant difference in eye health outcomes for people with thyroid eye disease. 

Diagnosis

Thyroid eye disease is rare and can be difficult to diagnose. Depending on how the disease presents, your eye doctor might use any of the following:

• Visual examination
• Examination with an exophthalmometer (a special instrument used to measure how far the eyes protrude from their normal position)
• Eyelid measurements
• Eye pressure measurements

If your condition is significantly advanced, your doctor might also want to assess the level of tissue damage that has occurred. This may be done using a CT scan or an MRI scan.

Most people with thyroid eye disease will show abnormal thyroid hormone levels in their blood test results. However, some people with this condition have normal blood test results. Blood tests should never be the only test used to diagnose or rule out thyroid eye disease. 

Treatment

Treatment for mild cases of thyroid eye disease usually focuses on addressing specific symptoms to maintain higher quality of life. Some of the potential treatments are:

• Sunglasses to help with light sensitivity
• Cold compresses to reduce pain and swelling
• Glasses with prisms to correct double vision
• Artificial tears to alleviate dry eyes

In addition, many eye doctors recommend sleeping with your head elevated. This helps to reduce the pressure that would otherwise build up in your eyes overnight. 

More severe cases pose a potential risk to the patient’s sight and are treated using more aggressive methods. Some of the things your doctor might recommend to address include:

• Corticosteroids (in pill or ointment form)
• Radiation
• Surgery to reduce pressure in the eye, treat double vision, or reposition the eyelid

If thyroid eye disease advances far enough, emergency surgery may be required to prevent permanent damage to the optic nerve. Keep in close contact with your eye doctor if they have indicated that you may be approaching this stage of the disease. 

As of 2022, the U.S. Food and Drug Administration (FDA) approved a new drug called Tepezza, which is  shown to significantly reduce the level of eye protrusion experienced by patients with thyroid eye disease. 

When to See a Doctor

You should see a doctor anytime you experience new or worsening symptoms that could be related to thyroid eye disease. This is particularly important if you have already been diagnosed with a thyroid condition. This condition can worsen very quickly and may lead to poor outcomes if it is not stabilized with treatment. 

Prevention

There is no reliable way to prevent thyroid eye disease or any other autoimmune disorder. However, it may be helpful to:

• Eat a healthy, balanced diet
• Exercise regularly
• Minimize stress
• Avoid or quit smoking

How to Live with Thyroid Eye Disease

There is no cure for thyroid eye disease. The condition often goes away after a few months, but this is not guaranteed. If it does go away, the damage it has done to your eyes may not return to normal. 

Despite this, it is possible to live a happy and fulfilled life with thyroid eye disease. To do this:

• Manage your symptoms. Observe how your condition is affecting your life and ask your doctor for possible treatment options to address problem areas. This will help you maintain a high quality of life even while ill. 
• Treat any thyroid conditions you have. Uncontrolled thyroid problems will make thyroid eye disease worse.
• Live a healthy lifestyle. Exercise and a good diet are essential to managing autoimmune disease. 
• Avoid stress. Stress is a major factor in the development and progression of autoimmune disease. 
• Follow your eye doctor’s recommended course of treatment and keep in close contact with them. If your conditions worsens, you may need to adjust your course of treatment. 

FAQs

What are the first signs of thyroid eye disease?

The first signs of thyroid eye disease may include eye redness, eye pain, puffiness around the yes, and either dry or watery eyes. These symptoms ate usually mild in the early stages and grow more severe over time. 

Is thyroid eye disease curable?

Yes, sometimes. Once thyroid eye disease has stabilized, it usually remains stable for the rest of the patient’s life. At this point, the eyes may go back to normal. 

In some patients, the disease worsens over time even with treatment. 

Can thyroid problems cause eye problems?

Thyroid problems cannot directly cause eye problems. However, they have been linked to the development of conditions like thyroid eye disease. If you have a thyroid problem, monitor your eye health carefully for signs of this disease. 

References

1. Thyroid Eye Disease. (April 2020). Pacific Neuroscience Institute.

2. Thyroid Eye Disease Center. (2022). Casey Eye Center: Oregon Health and Science University.

3. Thyroid Eye Disease. (2020). National Organization for Rare Disorders.

4. Thyroid Eye Disease. (2022). Cleveland Clinic.

5. Autoimmune Disease: Why Is My Immune System Attacking Itself? (2022). Johns Hopkins Medicine.

6. Autoimmune Diseases. (July 2021). Cleveland Clinic.

7. Thyroid Eye Disease (TED or Graves Eye Disease). (2022). Kellogg Eye Center: University of Michigan Health.

8. What is Thyroid Eye Disease? (2022). Stanford Health Care.

9. An overview of thyroid eye disease. (December 2014). Eye and Vision.

10. Thyroid Eye Disease: Care Instructions. (August 2020). MyHealth Alberta.