Graves’ eye disease is also known as Graves’ ophthalmopathy or thyroid eye disease (TED).

Eye symptoms occur in around 40 percent of people with Graves’ disease. Symptoms are often mild, but Graves’ eye disease can impact quality of life.

TED is an autoimmune disease.

The immune system is designed to target and destroy invaders like bacteria or viruses. With an autoimmune disease, an otherwise healthy part of the body becomes the target.

In Graves’ disease, the thyroid is the target of the body’s immune attack. The immune response sometimes affects the muscles and tissue behind the eye, causing redness, irritation, and swelling.

This can cause the eye to bulge out, changing its shape and appearance. Swelling can put pressure on the optic nerve, requiring intervention.

Early anti-inflammatory treatment can shorten the duration of TED flare-ups. Mild cases often resolve on their own. There are also ways to manage the symptoms while TED is active.

Graves’ disease must be properly managed during the active phase, but treatment for TED can help users progress out of this phase. In some cases, eye drops, cool compresses, or glasses with a prism may be enough to help manage symptoms.

You may need medications to help reduce the immune response and swelling. Taking an oral or intravenous corticosteroid may be appropriate.

Anti-thyroid drugs such as thionamides have been shown to address high thyroid levels in the short term. Teprotumumab-trbw (Tepezza) is a medication specifically approved for the treatment of TED.

There have also been advances in surgical treatment for TED that help restore the function and appearance of your eyes.

Inflammation of the tissues and muscles around the eye causes it to bulge. The immune response can cause so much swelling that the eye gets pushed forward and out of the socket.

Medications can help reduce the immune response or target the swelling. Prednisone or injected steroids are sometimes used.

Surgery is another option to correct the position of the eyes.

In orbital decompression surgery, tissue or bone is removed from behind the eye, creating space for the eye to fit back into position. It’s generally done once inflammation is under control.

In some cases, the procedure is done in the active stage to help prevent damage to vision. Eyelid surgery can correct a retracted eyelid once the condition is well managed.

Other sculpting surgeries can help restore the eye’s shape and appearance.

Graves’ disease doesn’t go away, but it can be successfully managed. Graves’ disease and thyroid eye disease are connected — but separate — conditions. TED will follow its own course.

Management of Graves’ disease involves getting thyroid hormone levels into a target range.

In Graves’ disease, thyroid levels are initially high. There are different ways to help slow or block thyroid production. These include:

  • Antithyroid medications. These medications block the thyroid from making thyroid hormones. Methimazole is the oral medication used most often. It has fewer side effects than other types.
  • Radioactive iodine. This has been a treatment for Graves’ disease in the past. Radioactivity destroys parts of the thyroid, which causes it to make less hormone. However, multiple studies have shown it to worsen symptoms of thyroid eye disease.
  • Surgery. A thyroidectomy removes the thyroid, which means the body can’t make thyroid hormone.
  • Beta-blockers. These oral medications don’t directly target the thyroid or amount of hormone in your body. Instead, they control your body’s response to thyroid hormones. They can help reduce the symptoms of hyperthyroidism.

After treatment for Graves’ disease, thyroid levels can drop below target. To balance hormone levels, you may need synthetic thyroid hormone pills. These medications have been shown to be a safe treatment option.

Side effects only occur if thyroid levels get too high or low. Blood levels of hormones will be closely monitored to make sure you get the right dose.

It’s important to note that TED can still occur even when thyroid levels are well managed.

The active (flare) stage of thyroid eye disease can last from 6 months to 2 years. Treatments can help shorten this phase.

Smoking or being around someone who smokes can make symptoms worse. If you smoke, you may want to consider cutting down or quitting. It’s also important to reduce your exposure to secondhand smoke.

Using eye drops or thicker lubricating gels at night can help reduce eye irritation. Sometimes your healthcare provide may recommend medications, including prednisone.

There are also intravenous steroid treatments, which typically have fewer side effects than oral steroids.

One or more surgeries may be needed. They include orbital decompression surgery, eye muscle surgery, and eyelid surgery.

If symptoms are affecting vision, surgery may be needed in the active stage. Typically, surgery is delayed until the inactive stage.

Surgery can help restore normal shape and function of the eye, eyelid, and area around the eye.

Graves’ disease and Graves’ eye disease are two connected autoimmune conditions.

Cases of Graves’ eye disease are often mild and resolve in time. Medication or surgery may be required and can counter the symptoms of active TED.

Advances in treatments are available to help you get back to feeling like yourself again.