Thyroid Eye Disease Overview

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Thyroid eye disease is when the immune system attacks and damages the muscles and other tissues around the eyes. Early symptoms may include dry, itchy eyes that look red and feel gritty.

As the condition progresses, inflammation can cause difficulty moving or closing the eyes. Rarely, thyroid eye disease can be severe enough to cause vision loss.

Thyroid eye disease sometimes develops in people with thyroid disease, especially Graves' hyperthyroidism.

symptoms of thyroid eye disease
 Illustration by Emily Roberts, Verywell

Symptoms of Thyroid Eye Disease

Early symptoms of thyroid eye disease may include:

  • Itching, dry eyes, and difficulty wearing contact lenses
  • Excessively watery eyes
  • Red or bloodshot eyes
  • 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.
  • Pain when moving the eyes up, down, or sideways
  • Light sensitivity
  • Double vision (diplopia)

Thyroid eye disease can cause inflammation and swelling that may affect the eyes as well as the muscles and other tissues around the eyes. As the disease progresses, symptoms can include the following:

  • Increased sensitivity to light
  • Impaired vision
  • Difficulty moving or closing the eyes

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

Who Gets Thyroid Eye Disease?

People with Graves' disease are at higher risk for developing thyroid eye disease. By some estimates, up to 50% of people with Graves' disease also have symptoms associated with thyroid eye disease.

The condition, however, is sometimes 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 healthcare provider 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.

Autoimmune eye disease in people with thyroid problems goes by several names, including: 

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

Treatment of Thyroid Eye Disease

For a mild case, use lubricating eye drops and artificial tears a few times during the day. Avoid wind and bright light.

If you have severe symptoms, your healthcare provider 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.

Frequently Asked Questions

  • Who is most at risk for thyroid eye disease?

    Females, middle-aged people, and smokers are more likely to develop thyroid eye disease.

  • Can thyroid eye disease be cured?

    Thyroid eye disease is not considered curable, but symptoms can be managed so that discomfort is minimal.

  • What is Graves' disease?

    Graves' disease is an autoimmune disease in which the immune system stimulates thyroid cells and causes them to be overactive, leading to hyperthyroidism.

13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Thyroid Eye Disease. American Society of Ophthalmic Plastic & Reconstructive Surgery.

  3. Thyroid Eye Disease. Cleveland Clinic.

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  5. Barrio-barrio J, Sabater AL, Bonet-farriol E, Velázquez-villoria Á, Galofré JC. Graves' Ophthalmopathy: VISA versus EUGOGO Classification, Assessment, and Management. J Ophthalmol. 2015;2015:249125.  doi:10.1155/2015/249125

  6. Thyroid Eye Disease. Cleveland Clinic. 

  7. Estcourt S, Quinn AG, Vaidya B. Quality of life in thyroid eye disease: impact of quality of care. Eur J Endocrinol. 2011;164(5):649-55.  doi:10.1530/EJE-11-0055

  8. Maheshwari R, Weis E. Thyroid associated orbitopathyIndian J Ophthalmol. 2012;60(2):87–93. doi:10.4103/0301-4738.94048

  9. Bahn RS. Graves' ophthalmopathy. N Engl J Med. 2010;362(8):726–738. doi:10.1056/NEJMra0905750

  10. Ismailova DS, Belovalova IM, Grusha YO, Sviridenko NY. Orbital decompression in the system of treatment for complicated thyroid eye disease: case report and literature review. Int Med Case Rep J. 2018;11:243-249.  doi:10.2147/IMCRJ.S164372

  11. Harrad R. Management of strabismus in thyroid eye disease. Eye (Lond). 2015;29(2):234-7. doi:10.1038/eye.2014.282

  12. McAlinden C. An overview of thyroid eye diseaseEye and Vis. 2014;1(1):9. doi:10.1186/s40662-014-0009-8

  13. American Thyroid Association. Graves' eye disease.

Additional Reading
  • 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.

By Troy Bedinghaus, OD
Troy L. Bedinghaus, OD, board-certified optometric physician, owns Lakewood Family Eye Care in Florida. He is an active member of the American Optometric Association.