Thyroid eye disease

What is thyroid eye disease?

Thyroid eye disease (TED), also known as Graves orbitopathy or Graves ophthalmopathy, is a condition in which parts of the eye and eye socket become inflamed and swell. It’s an autoimmune disorder, which means that the body uses its natural defences against its own cells.

What causes thyroid eye disease?

We don’t fully understand what causes thyroid eye disease. But we do know that the body’s immune system triggers a chain of events that leads to swelling and scarring around the eye socket as well as an increase in the amount of tissue. TED is most likely to affect people with an over-active thyroid gland.

What are the signs and symptoms of thyroid eye disease?

The most common symptoms of TED are eye redness and discomfort. It usually affects both eyes.

Other symptoms can include:

• Eyes which appear pushed forward (known as proptosis). This is caused by swelling of the fat and muscle behind the eye and may prevent the eyelids from completely meeting when blinking or closing the eyes (known as lagophthalmos). 
• Eyelids may open too far (eyelid retraction), exposing the clear, sensitive window of the eye (the cornea) to damage. The cornea may become dry and uncomfortable.
• Redness or swelling - the conjunctiva (a thin membrane that covers the white of the eye and lines the inside of the eyelid) can become inflamed (conjunctivitis), or swell (chemosis).
• Eye movements are reduced in some people - this can cause double vision. 

Is thyroid eye disease serious?

It depends - some cases resolve on their own, but TED can cause a range of problems with your eyes and in extreme cases, the optic nerve can be squeezed, which could potentially cause sight loss. So it's important to get medical attention for TED, to manage symptoms and prevent complications.

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How is thyroid eye disease diagnosed?

Diagnosis typically involves a clinical examination by a healthcare professional. They will look for the signs and symptoms of TED outlined above, such as eyes that are pushed forwards or eyelids that do not completely close. They will also look for signs of thyroid problems like overactive thyroid and/or a goitre (swelling of the thyroid gland at the front of your neck). 

What are the treatments for thyroid eye disease?

In many cases, the swelling and inflammation may get better on their own, but a doctor may suggest lubricating eye drops or nutrition supplements to help while this happens.

If the swelling and inflammation are moderate or severe, a doctor may suggest therapy with steroids. Other ways to tackle inflammation include treatment with radiotherapy or drugs called monoclonal antibodies, such as rituximab.

When the inflammation has settled, orbital decompression surgery may be an option. This involves removing part of the walls of the eye sockets and sometimes some of the surrounding tissue. The aim is to help the eyes move back into their sockets and take pressure off the optic nerve. Decompression surgery is sometimes done in an emergency if there is a threat to sight.

Surgery to improve double vision (squint surgery) and to repair the eyelids may also be needed.

Any problems with the thyroid gland, such as an overactive thyroid, need to be treated as otherwise this could make TED worse. 

What can help thyroid eye disease?

In addition to medical treatments, lifestyle changes can help manage TED. Stopping smoking is crucial as it is a known risk factor that worsens TED. Lubricating eye drops and nutritional supplements may provide relief. Proper management of thyroid gland activity is also essential to prevent exacerbation of TED.

What research is there into thyroid eye disease?

TED medical research is all about getting a better understanding of the condition so that we can develop treatments to prevent it and improve people’s quality of life. Steroids do work for some people, but not for everyone. They may also cause unwanted side effects, so we do need better treatments.

See our research projects