An Overview of Thyroid Eye Disease

Bulging eyes
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People with thyroid disease sometimes develop an eye condition that causes the immune system to attack the muscles and other tissues around the eyes. This inflammation can cause the eyeballs to bulge from their sockets. Rarely, it can be severe enough to cause vision loss.

There are many different names you might find for the autoimmune eye condition that is often seen in people with thyroid disease. These names include: 

  • Thyroid eye disease, sometimes abbreviated as TED
  • Graves' opthalmopathy (GO)
  • Thyroid-associated orbitopathy (TAO)
  • Grave's orbitopathy

Symptoms

Thyroid eye disease can cause inflammation that may affect the muscles and other tissues around the eyes. Symptoms often include the following:

  • Pain in the eyes when looking up, down, or sideways
  • Dryness, itching, dry eyes, difficulty wearing contact lenses
  • Inflammation and swelling of the eye and its surrounding tissues
  • Swelling of the orbital tissues which causes the eye to be pushed forward referred to as exophthalmos, which can make people with thyroid eye disease appear to have a wide-eyed or bulging, protuberant stare.
  • Bloodshot eyes
  • Double vision (diplopia)
  • Light sensitivity
  • Impaired vision
  • Difficulty moving the eyes

Thyroid eye disease is known to go through varying degrees of severity and can go into periods of remission. It often lasts one to two years. When it has been inactive for a period of around a half a year, it's less likely to recur.

Causes

Thyroid eye disease is an autoimmune eye condition that, while separate from thyroid disease, is often seen in conjunction with Graves' disease. About 25 to 30 percent of people with Graves' disease have a mild form while only a tiny percentage develop a severe form.

The condition, however, is seen in people with no other evidence of thyroid dysfunction, and occasionally in patients who have Hashimoto's disease. Most thyroid patients, however, will not develop thyroid eye disease, and if so, only mildly. Smoking is associated with a worsening of symptoms.

Diagnosis

If you have hyperthyroidism and begin to experience symptoms involving your eyes, you should have a complete eye exam by an ophthalmologist. (If you have never had issues with your thyroid, a simple blood test will be ordered to check your thyroid levels.) Your doctor may find swelling and enlargement of the eye muscles. A CT scan or MRI scan of the eyes may be used to examine any swelling of the tissues behind the eye, in order to confirm the diagnosis.

Treatment 

For a mild case, instill lubricating eye drops and artificial tears a few times during the day. Avoid wind and bright light. If you have severe symptoms, your doctor may prescribe corticosteroids such as prednisone to reduce swelling. In a very small percentage of patients, orbital decompression surgery may be recommended. This procedure removes the bone between the eye socket and the air sinus behind it so your eye has more room. This can improve your vision but there is a risk of double vision.

Double vision can also occur when scar tissue from the ophthalmopathy makes an eye muscle too short. Eye muscle surgery can be used to attach the muscle at a point where it will again be the correct length to provide single vision. However, more than one surgery may be needed to be successful.

A Word From Verywell

If you are diagnosed with thyroid eye disease, be sure to wear sunglasses while in the sun. Your eyes will be more sensitive to the sun and wind and more vulnerable to ultraviolet rays. You may also try elevating the head of your bed to help relieve the pressure and swelling. Cool compresses may also help provide relief.

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Article Sources
  • Baze, Elizabeth F., MD; David A. Weinberg, MD; Raymond S. Douglas, MD, PhD; Shivani Gupta, MD, MPH. "Thyroid Eye Disease." American Academy of Ophthalmology (AAO), 24 Mar 2014.

  • Boyd, Kierstan. "What Is Graves Disease?" American Academy of Ophthalmology (AAO), 1 Sept 2017.