Thyroid eye disease (TED)

Thyroid eye disease (TED) or Graves Ophthalmopathy is a condition in which the fatty tissue around and behind the eye, the muscles of the eye, conjunctiva, tear glands and skin may become inflamed and/or enlarged due to an active autoimmune process. This may lead to eye discomfort, a change in appearance, double vision, protrusive eyes, or vision loss. In some situations, it may impact one’s quality of life, ability to work or drive. Severe eye disease is diagnosed in approx. 5% of people with thyroid eye disease.

Thyroid eye disease is usually diagnosed in patients who have related autoimmune thyroid disorders, most commonly Graves’ Disease. Rarely, thyroid eye disease can be diagnosed in patients with normal thyroid function.

Smoking, thyroid dysfunction, radioactive iodine, pregnancy, high cholesterol, and stress are risk factors associated with this condition. Adequate control of thyroid dysfunction is of utmost importance as both over and under-active thyroid function negatively impact thyroid eye disease.

Thyroid eye disease generally progresses through an active, inflammatory stage lasting approx. 6-24 months and then stabilizes into a chronic phase in most patients.

Active Phase Symptoms

  • eye discomfort
  • pain behind the eye
  • eye redness
  • tearing
  • swelling (puffiness)
  • eyelid retraction
  • intermittent or constant double vision
  • protruding eyes
  • vision loss

Typically, during the active disease, patients are managed conservatively with lubricating eye drops and selenium supplementation if thyroid eye disease is classified as mild, and/or with high dose intravenous corticosteroids over a 12-week course if moderate or severe. Corticosteroids are usually successful in treating active inflammation but are often not effective in addressing the double vision and eye protrusion (also called proptosis or exophthalmos). Other immunomodulatory drugs such as mycophenolate, tocilizumab or others may be added to your treatment if your disease is severe or not responsive to steroid treatment. If thyroid eye disease is affecting your eyesight, eyelid or orbital decompression surgery may be urgently required to stop further vision loss.

Once entered in the chronic phase, thyroid eye disease may spontaneously improve over time. Surgical procedures may be offered to address appearance and double vision issues. Surgical rehabilitation of thyroid eye disease can include orbital decompression, eye muscle (strabismus) and/or eyelid surgery. Although medical and surgical treatments are relatively successful overall, patients with severe thyroid eye disease may be left with significant residual disability.

This content has been medically reviewed by Dr Alexandra Manta and is for information purposes only. Consult a medical professional for advice.

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