Thyroid eye disease (TED) is also known as Graves’ ophthalmopathy. TED and Graves’ disease are part of the same autoimmune disease.
In Graves’ disease, the immune system mistakes healthy thyroid tissues for invaders. This immune attack causes an overproduction of thyroid hormone.
In TED, the immune system attacks fatty tissues and muscles behind the eye. TED can occur at any stage of Graves’ disease, even when thyroid levels are in a normal range.
Around one-third of people with Graves’ disease will develop eye symptoms.
There are treatments available to help with your symptoms. Home treatments, medications, and surgeries are available.
Read on to find out more about how the signs and symptoms of TED are managed.
There are different treatments available for thyroid eye disease. Treatment decisions will depend on your symptoms and the severity of your symptoms.
In January 2020, the Food and Drug Administration (FDA) approved teprotumumab (Tepezza) as the first prescription medication for active TED. The intravenous (IV) medication may reduce symptoms including eye bulging (proptosis) and double vision (diplopia).
Dry, red, swollen, and irritated eyes are common with TED. To help manage dry, irritated eyes, your healthcare provider may recommend:
- lubricating eye drops throughout the day
- thicker lubricating eye drops or gels for nighttime
- cool compresses to soothe eyes and reduce swelling
Wear sunglasses indoors and outdoors if your eyes are light sensitive.
If double vision is a problem, your eye specialist may recommend glasses with a prism. This helps redirect light so you will only see a single image.
Smoking can make symptoms worse. If you smoke or spend a lot of time with someone who smokes, you may want to consider ways to smoke less or reduce your exposure. It’s never too late to cut down or quit.
In some cases, TED may require surgery. Surgery can help restore normal eye function and appearance. There are three main surgeries for TED. Sometimes more than one surgery is done, with time in between to heal.
Surgeries for TED include:
- Orbital decompression surgery. Excess swelling behind the eye can push the eye out of position. This surgery removes excess tissue or bone, creating space for the eye to go back into place.
- Strabismus (eye muscle) surgery. Scar tissue can build up on the muscles connected to the eye, limiting the eye’s ability to move around. This surgery reattaches the eye to healthier muscles.
- Eyelid retraction surgery. When swelling pushes the eye out of position, the eyelids may not be able to fully close. This surgery fits the eyelids back into place. It’s done by removing muscle or scar tissue or adding more skin to lengthen the eyelid.
In the active phase of TED, fatty tissues behind the eye are under attack by the immune system. Excess fluid can build up in that area, resulting in bulging eyes and pressure on the optic nerve. When the eye is not in its proper position, the eyelid may not be able to close all the way.
There are a few home remedies that may help your eyes feel better. Elevating the head of your bed may help excess fluid to drain away from your eyes. A cool compress can also provide some relief.
Your doctor may recommend that you take
Orbital radiation therapy may be used if symptoms are not responding to prednisone. It’s sometimes used along with prednisone. Radiation can remove some of the tissue behind the eye to provide relief of symptoms.
TED has an active stage that can last anywhere from several months to several years. The active stage is followed by an inactive stage. This is when the immune attack stops and the tissues behind the eyes are no longer being damaged.
You may still need some treatment in the inactive stage. Changes to the eye structure during the active stage may need surgery. Your healthcare provider will delay any required surgeries until the active stage is over.
Managing your Graves’ disease is an important part of taking care of yourself. However, it won’t resolve or prevent TED. They are part of the same autoimmune disease but follow their own separate courses.
Around one-third of people with Graves’ disease will also develop thyroid eye disease. Some will only need treatment for minor symptoms. Others will have symptoms that require ongoing treatments and possibly surgery.
Your healthcare team can work with you to determine the best approach for you.