Thyroid Eye Disease (TED), also known as Graves' Ophthalmopathy, is an autoimmune condition that affects the muscles and tissues around your eyes. It's most commonly associated with Graves' disease—a thyroid disorder that leads to an overactive thyroid gland (hyperthyroidism). However, TED can also occur in people with normal thyroid levels or an underactive thyroid (hypothyroidism). Symptoms can range from mild irritation to serious vision problems.

Causes of Thyroid Eye Disease

TED occurs when your immune system mistakenly attacks the tissues around your eyes. This immune response causes inflammation and swelling, leading to the symptoms of TED.

Symptoms of Thyroid Eye Disease

The symptoms of TED can vary widely from person to person. Common signs include:

Bulging Eyes (Proptosis): Swelling behind the eyes can make them appear to bulge or protrude.
Dryness and Irritation: You may experience dryness, discomfort, or a gritty feeling in your eyes.
Redness and Swelling: Inflammation can cause your eyes and eyelids to become red and swollen.
Double Vision (Diplopia): Swollen muscles can misalign your eyes, leading to double vision.
Light Sensitivity (Photophobia): Your eyes may become more sensitive to light.
Restricted Eye Movement: You might find it difficult to move your eyes in certain directions.
Vision Loss: In severe cases, pressure on the optic nerve can lead to vision loss.

How Thyroid Eye Disease Affects Your Eyes

In TED, inflammation and swelling affect various parts of your eyes. In severe cases, the swollen tissues can press on the optic nerve—the nerve that connects your eyes to your brain. This condition, known as compressive optic neuropathy, can lead to permanent vision loss if not treated promptly.

Stages of Thyroid Eye Disease

TED typically progresses through two phases:

Active (Inflammatory) Phase: During this phase, inflammation is at its peak, and symptoms may gradually worsen. This phase can last from several months up to two years.
Inactive (Chronic) Phase: In this phase, inflammation decreases. However, some symptoms like bulging eyes or double vision may persist and might require additional treatment.

Diagnosis of Thyroid Eye Disease

Diagnosing TED involves several steps:

Comprehensive Eye Examination: An eye doctor will assess your vision, eye movement, and look for signs like bulging eyes or optic nerve involvement.
Imaging Tests: CT scans or MRI scans help visualize the extent of tissue swelling and detect any compression of the optic nerve.
Blood Tests: These tests evaluate your thyroid function to determine if your thyroid hormone levels are too high or too low.

Treatment for Thyroid Eye Disease

The goal of treatment is to reduce inflammation, manage symptoms, and prevent long-term damage to your eyes. Treatment plans are personalized based on the severity of your condition and may include:

Tepezza (teprotumumab): A new medication specifically approved for TED, Tepezza targets the underlying autoimmune response and has been shown to reduce eye bulging and other symptoms.

Corticosteroids: Steroid medications can reduce inflammation during the active phase.
Eye Drops and Lubricants: Artificial tears and lubricating eye drops can help alleviate dryness and irritation.
Prism Glasses: Special glasses with prisms can help align vision in cases of double vision.
Radiation Therapy: In some cases, low-dose radiation is used to reduce inflammation in the tissues around the eyes.
Surgery: Surgical options may be considered during the inactive phase or in severe cases:
- Orbital Decompression Surgery: This surgery creates more space in the eye socket to relieve pressure and reduce bulging.
- Strabismus Surgery: Adjusts the eye muscles to correct double vision.
- Eyelid Surgery: Corrects eyelid position to improve eye closure and appearance.

Managing Thyroid Eye Disease Long-Term

TED can have lasting effects even after the active phase ends. Regular follow-up with your eye doctor is crucial to monitor your condition and address any ongoing issues. Managing your thyroid hormone levels is also important, so working closely with your primary care doctor or endocrinologist is essential.

Our team at Hashemi Eye Care is dedicated to providing comprehensive care for patients with TED. We work collaboratively to monitor your condition and provide timely treatments to preserve your vision and improve your quality of life.

Learn more about TED at the North American Neuro-Ophthalmology Society

Take Control of Your Thyroid Eye Disease Today

Early diagnosis and treatment of Thyroid Eye Disease can make a significant difference in preserving your vision and eye health. If you're experiencing any symptoms, don't hesitate to reach out. Contact Hashemi Eye Care to schedule a consultation with our specialists today.

For more information about how we can help, visit our Neuro-Ophthalmology Care page to learn more about the conditions we treat.