Risk of vision loss from thyroid eye disease (TED) is low, but symptoms can result in more severe issues without treatment. Consult an eye doctor if you experience ongoing eye irritation, eye bulging, or eyelids receding.

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Bulging, red eyes. Eyelids that don’t close completely. Double vision. These are some clear symptoms of thyroid eye disease.

This article will provide more information about thyroid eye disease in general, and what you may want to know if you’re experiencing symptoms or researching treatments to discuss with your healthcare team.

Thyroid eye disease (TED) is an eye disorder resulting from Graves’ disease.

Graves’ disease, an autoimmune condition, occurs when autoantibodies bind to the thyroid and stimulate the release of too much thyroid hormone into the body. The same autoantibodies that attack the thyroid can bind to structures within the eye socket, inflaming the muscles and tissues around the eyes.

That causes the clear TED symptoms: protruding eyes and eyelids that don’t close completely.

Known by other names

TED is also commonly referred to as Graves’ eye disease. In medical literature, you’ll also find it called:

  • Graves’ orbitopathy
  • Graves’ ophthalmopathy
  • thyroid-associated orbitopathy
  • thyroid-associated ophthalmopathy
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TED has two phases:

Active phase

During the active phase, you may experience active eye swelling and inflammation. This phase can last from months to years. Symptoms can fluctuate in intensity over time.

Chronic phase

During this chronic phase, symptoms stabilize. While changes in symptoms stop during the chronic phase, physical changes to the eyes and eyelids can continue.

Signs and symptoms of thyroid eye disease can persist long after the issue with the thyroid gland has been treated.

Between 3% and 5% of people with TED are at risk of permanent vision damage due to compression of the optic nerve caused by swelling of eye socket tissues. Damage could also be a result of corneal ulcerations caused by chronic exposure due to the eyelids’ inability to fully close.

The most visible symptoms of TED are:

  • bulging eyes
  • puffy eyelids
  • eyelids that pull back more than usual or don’t fully close

People with TED can also experience:

  • dry eyes
  • double vision
  • light sensitivity
  • eye pain or pressure
  • difficulty moving eyes to see around

Thyroid eye disease usually affects both eyes, but it can also be present in one eye.

A doctor can diagnose TED during a thorough physical eye exam. If thyroid issues have not been diagnosed but are suspected, a thyroid test may be needed as a follow-up.

While thyroid eye disease is the result of the body’s immune system attacking and inflaming the muscles and tissues around the eyes, it’s unclear what triggers that response.

The following risk factors may increase the risk of thyroid eye disease:

  • having a family history of Graves’ disease
  • having other autoimmune diseases — such as Hashimoto’s thyroiditis, vitiligo, type 1 diabetes, autoimmune gastritis, and rheumatoid arthritis — in addition to Graves’ disease
  • smoking or being exposed to secondhand smoke
  • being female
  • being younger than age 40
  • having prior radioactive iodine treatment

A variety of treatments are available to address thyroid eye disease. These treatments include over-the-counter (OTC) eye drops, medications, lifestyle changes, surgery, and, in rare cases, radiation.

Treating the underlying thyroid issue may also relieve symptoms.

Eye drops and medications

OTC eye drops, sometimes referred to as artificial tears, are commonly used to reduce eye dryness and irritation.

In 2020, the Food and Drug Administration (FDA) approved Tepezza (teprotumumab-trbw), a medication for the treatment of thyroid eye disease in adults. This biologic medication is administered intravenously. In clinical trials, Tepezza significantly reduced eye protrusion, a common symptom of thyroid eye disease.

Lifestyle changes

Some lifestyle changes can also improve your symptoms. Your doctor may suggest the following:

  • eliminating exposure to smoke (both from smoking and secondhand smoke)
  • wearing sunglasses in response to light sensitivity
  • sleeping with your head raised to counter eye puffiness
  • taping eyelids shut or wearing an eye mask while sleeping to prevent dry eye
  • wearing special eyeglasses that are prescribed for double vision


A doctor may recommend surgical procedures to address more severe symptoms. The procedures include:

  • Orbital decompression surgery: This procedure makes the eye socket bigger, eases pressure on the optic nerve, and moves the eye back into its proper position. The goal is to preserve vision, eye function, and comfort. It doesn’t alter the clinical course of the underlying condition.
  • Eyelid surgery: This procedure can help prevent the eyelids from pulling back too much or not closing completely.

In extremely rare cases, targeted radiation therapy may be used to reduce swelling.

About 1 in 3 people with Graves’ disease will develop a related eye condition. While thyroid eye disease rarely leads to vision loss, it’s not completely without risk.

The symptoms are often mild and can go away on their own after 1 or 2 years. However, it’s important to speak with your doctor if you experience any TED symptoms.

If the orbital swelling that comes with TED presses on the optic nerve or if corneal ulcerations develop from exposure, your vision may be affected.

Who is most likely to get thyroid eye disease?

According to some research, people who are most at risk of developing thyroid eye disease are people between the ages of 45 and 65, female adults, and people who smoke.

What are the first signs of thyroid eye disease?

The first signs or symptoms of thyroid eye disease are: protruding eyes, red and irritated eyes, eyelids that won’t close completely, and double vision.

What triggers thyroid eye disease?

Both Graves’ disease and thyroid eye disease are autoimmune conditions. The same autoantibodies that stimulate the thyroid gland to release excess thyroid hormone are believed to be a cause.

Other autoimmune conditions such as type 1 diabetes, rheumatoid arthritis, and Hashimoto’s thyroiditis are also believed to be causes.

If you begin to notice common symptoms of TED — such as eye irritation, eye bulging, or the inability to fully close your eyelids — it’s important to speak with your doctor or eye care team.

While TED rarely causes vision loss, it can be uncomfortable. Your doctor or eye care team can determine a treatment plan that works for you.