Thyroid eye disease (TED) is an autoimmune condition associated with Graves’ disease. It’s also known as Graves’ eye disease or Graves’ ophthalmopathy.
It occurs when the immune system attacks the muscles and tissues behind the eye, causing inflammation in and around the eye. Sometimes the swelling can start to push the eye out of position and affect vision.
Many people who develop eye symptoms will have mild cases.
There are things you can do to help manage your symptoms during active TED. If the condition is more severe, medications and surgeries can shorten the disease’s course and address physical concerns.
Symptoms vary depending on the amount of swelling behind the eye. Typically the active phase of TED lasts from 6 months to 2 years.
Common symptoms include:
- eye redness and irritation
- dry eyes
- swelling around the eye
In some cases, there can be visible bulging of the eye. If the eye is pushed forward, or the eyelids become swollen, it can be difficult to close the eye fully. The exposed part of the eye can become very irritated.
These eight common treatments can help relieve symptoms of the disease.
There are many different types of eye drops. Some are available over the counter and others are by prescription.
- Artificial tears. These are available without a prescription. They lubricate your eye to soothe dryness and irritation. They’re designed to be similar to the tears that your eye produces. You can get them with and without preservatives. If you’re using them more than four times daily, it’s best to use a type without preservatives.
- Lubricating gels. These are similar to artificial tears but thicker. They last longer than artificial tears. They can temporarily blur your vision, so many people choose to use these before bed.
- Steroid eye drops. These drops help to reduce eye pain and swelling and can be helpful for people with TED. Steroid eye drops have fewer side effects than oral steroids.
It’s best to avoid “red eye relief” eye drops if you have TED, even if your eyes are really red. Red eye relief can make your eyes drier and more irritated over time.
Always follow your healthcare provider’s advice about the type of eye drops you should take and how often you should take them. Some drops need to be shaken before use.
Once you’ve gotten the right type of eye drop, the key is to actually get it into your eye. This can take some practice.
Here are some tips:
- Wash your hands to avoid contaminating the eye drops.
- Tilt your head back to look towards the ceiling, or lie down if that’s easier.
- Use one finger to gently pull down your bottom lid.
- Position the tip of the eye drop bottle over the space you created by lowering the bottom lid.
- Gently squeeze the drop bottle to release one or two drops into your eye.
- Keep your eye closed for a few minutes once the drops are in.
A cool compress can soothe red and irritated eyes. The cool temperature decreases blood flow to the area and can reduce swelling.
You can buy a reusable eye mask that you put in the fridge or freezer to cool down before using. You can also try a washcloth soaked in cool water. These can be used as needed.
Being in a dry environment can make irritated eyes feel worse. If you need to be outside on a windy day, wear glasses or sunglasses that protect all sides of your eyes. Being near a fan or in air conditioning for too long can also be drying.
You may want to limit the time you spend outside on a cold, dry day. Winter air contains less moisture and can leave you feeling drier. Plan to use extra lubricating eye drops before and after being outside.
If you have the heat or air conditioning on while you drive, direct the vents away from your face.
If you’re experiencing light sensitivity, wearing wraparound sunglasses can help. You may want to keep extra pairs around the house, in a backpack or bag, and in the car. That way, they’re available when and where you need them.
If your eye is protruding due to swelling, it may be difficult to close your eyes. When the eyelid doesn’t cover the whole eye, your eye is unprotected and will feel even more irritated.
Taping your eyes shut before bed is a way to prevent them from drying out overnight. There are special medical tapes designed for this. They’re strong enough to hold the eye shut but gentle enough for the sensitive skin on the eyelid.
Smoking is associated with
If you’re feeling ready to quit, talk to your doctor. There are medications and other forms of support. It’s never too late to cut down or quit.
For mild cases of TED, selenium supplements may prevent symptoms from getting worse.
A large double-blind trial found that people who took selenium supplements had better outcomes and fewer symptoms. The dose used in the study was equal to 93.6 microgram (mcg) selenium daily.
Check with your doctor or pharmacist before starting a new supplement.
Sometimes medications can help reduce swelling when eye drops aren’t enough. Prednisone is an oral steroid medication that may be used. The drug teprotumumab-trbw (Tepezza) is specifically for TED and has been shown to reduce bulging.
It’s important to keep in touch with your healthcare team. Let them know if treatments aren’t helping or things are getting worse.
Other treatments may work better for you. Surgeries to improve the eye’s function and appearance may also be an option.
Many people with thyroid eye disease have mild cases. Common symptoms include dry, irritated eyes, and swelling in and around the eye.
There are strategies that can help to manage these symptoms. Medications, procedures, and surgeries may also be part of treatment for TED.
Talk with your healthcare team so they’re up to date on how you’re managing.