Thyroid Eye Disease Overview

Thyroid eye disease sometimes develops in people with thyroid disease, especially Graves' hyperthyroidism. When you have this condition, your immune system attacks and damages the muscles and other tissues around the eyes.

Thyroid eye disease symptoms can include redness and a dry, itchy, or gritty sensation in the eyes. 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.

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.

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. If treatment with corticosteroids does not work, your healthcare provider may recommend Tepezza (teprotumumab-trbw). Tepezza is the only medication approved by the Food and Drug Administration (FDA) to treat thyroid eye disease.

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.