Thyroid eye disease (TED) is an autoimmune disorder. TED is an attack by the body’s own immune system on the eye muscles and the tissue behind the eye, which inflames both areas. Thyroid eye disease is also known as Graves’ eye disease and Graves’ orbitopathy because the majority of TED patients also have the overactive thyroid condition called Graves’ disease. However, people who have normal thyroid function and patients with underactive thyroids can experience TED. Thyroid eye disease may have a course of up to two years.
Eye pain when looking sideways, up or down is a frequent TED symptom. Other thyroid eye disease symptoms include eye swelling, eye redness, bulging eyes, double vision, and sensitivity to light. Thyroid eye disease can also cause eyes to be dry or itchy. The severity of symptoms can vary between patients. Also, the severity of symptoms a patient experiences may change over the course of the disease.
Approximately 25% of Graves’ disease patients also develop thyroid eye disease. Women develop TED more often than men. Smoking and second-hand smoke exposure increase the risk of thyroid eye disease.
Patients with a history of an overactive or underactive thyroid need to maintain stable thyroid function. Many cases of TED involve eye redness and mild discomfort. Mild cases of TED can be addressed with self-care measures such as artificial tears, wearing sunglasses, applying cool compresses, and elevating the head of the bed. Also, a vitamin regimen of selenium and Vitamin D may be recommended to patients with mild thyroid eye disease.
Additional treatment options are available for severe cases of thyroid eye disease. Since smoking is associated with more severe TED symptoms, smokers with thyroid eye disease are encouraged to undertake a smoking cessation program. Steroids such as hydrocortisone or prednisone may be prescribed to reduce inflammation. If pressure from TED on the nerve behind the eye threatens the patient with vision loss, orbital decompression surgery may be performed. TED patients who are experiencing double vision may be given glasses with prisms. Eye muscle surgery is also an option for thyroid eye disease patients with double vision. Finally, eyelid surgery is offered to patients for cosmetic reasons or to reduce irritation from the inability to close the eyelid.