What Is Thyroid Eye Disease?

Thyroid eye disease sometimes develops in people with thyroid disease, especially Graves' hyperthyroidism (overactive thyroid). With 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. In about 4% to 8% of cases, thyroid eye disease can be severe enough to cause complications including vision loss.1

This article explains the symptoms of thyroid eye disease and who may be most at risk. It will help you to understand how thyroid eye disease is diagnosed and treated.

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 (around the eyes). This leads to exophthalmos, which can make people with thyroid eye disease appear to have a wide-eyed or bulging, protuberant stare.2
• Pain when moving the eyes up, down, or sideways3
• 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.3 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.4

The condition, however, is sometimes seen in people with no other evidence of thyroid dysfunction. That may be more likely to occur in:5

• People assigned female at birth
• Middle-aged people
• Smokers

Occasionally, thyroid eye disease occurs in people living with Hashimoto's disease. Most people diagnosed with a thyroid disorder, however, will not develop thyroid eye disease, and if so, only mildly. Smoking is associated with a worsening of symptoms.6

How Is Thyroid Eye Disease Diagnosed?

Thyroid eye disease may be diagnosed at the same time as a thyroid condition. 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.

If you have never had issues with your thyroid, a simple blood test will be ordered to check your thyroid levels. If you have hyperthyroidism and begin to experience symptoms involving your eyes, you should have a complete eye exam by an ophthalmologist (eye specialist).

How Is Thyroid Eye Disease Treated?

Thyroid eye disease is not considered curable, but symptoms often are managed so that discomfort is minimal. For a mild case, lubricating eye drops and artificial tears used a few times during the day can help. Elevating the head of your bed may help to relieve pressure and swelling.

Your eyes will be more sensitive to the sun and wind and more vulnerable to ultraviolet rays. Be sure to wear sunglasses. Cool compresses may also help provide relief.

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).

In a very small percentage of cases, orbital decompression surgery may be recommended.9 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.10 However, more than one surgery may be needed to be successful.

Summary

Thyroid eye disease is common among people diagnosed with Graves' disease and occurs in roughly half of all cases. Certain groups of people also appear to be more at risk, including assigned females, people in middle age, and people who smoke.

Symptoms of thyroid eye disease (sometimes called thyroid-associated or Graves' orbitopathy) include pain, pressure, itching, or redness of the eyes. You also may be sensitive to light. Serious complications may involve double vision or even vision loss.

Your healthcare provider may treat thyroid eye disease with the use of prednisone or another corticosteroid. The medication Tepezza also may be prescribed. Surgery may be needed in more serious cases, in order to relieve pressure on the eye.