Thyroid Eye Disease

What is thyroid eye disease?

Thyroid eye disease is swelling and inflammation around the eye related to thyroid hormone problems.

It is more common if your body makes too much thyroid hormone, a problem sometimes called Graves' disease.

What is the cause?

The exact cause of thyroid eye disease is not known. It is thought to be an autoimmune disease. This means that the body's defenses against infection attack the body's own tissue, causing inflammation in and around the eye socket.

Although most common in people with high or low thyroid hormone levels, thyroid eye disease can happen even if you have normal thyroid hormone levels. It may get worse when thyroid disease is treated. People who smoke are more likely to have thyroid eye disease.

What are the symptoms?

Symptoms of thyroid eye disease may include:

• Eyes that are pushed forward more than usual from the sockets, and eyelids that do not completely close over the eye. Even if the eyes are not protruding, they may appear to be bulging because the eyelid closes over less of the eye and the white of the eye is visible all around the iris (the colored part of the eye). The 2 eyes may look different.
• Dry, red eyes with a scratchy feeling. The dryness may happen because your eyelids are not covering enough of your eye or they do not close all the way. This can especially be a problem when you are sleeping. The eye may dry out while you sleep and become damaged.
• Tearing (which is your body's response to dry eyes).
• Double vision if the muscles that control eye movements are affected.
• Swelling of the eye and the tissue around the eye.
• Decreased vision from eye dryness or from pressure on the optic nerve due to the swelling of the eye socket.

How is it diagnosed?

Your eye care provider will give you a complete eye exam. This will include checking your cornea, optic nerve, eye movement, and eyelid and eye position. You may have a blood test to check thyroid hormone levels. Sometimes an ultrasound or a CT scan of the eye sockets is needed to check the swelling of the eye muscles and tissues of the eye socket.

How is it treated?

Your provider may prescribe medicine to control your thyroid hormone levels. You may need regular blood tests to check your hormone levels and make sure they are in good control.

Artificial tears or ointment at night can help dry eyes. Sometimes steroid drugs or low doses of radiation are used to reduce the swelling around the eye. If you have double vision, special prisms can be put on your glasses.

Sometimes surgery is done to help you have a more normal appearance or to improve or keep your vision. The surgery may:

• Remove some of the bone from the eye sockets in your skull so there is more room for swollen tissues.
• Change the eye muscles so that you stop having double vision.
• Change the shape of your eyelids so they close better.

How long do the effects last?

Some symptoms, such as tearing or a scratchy feeling in your eyes, can be relieved by using eyedrops or ointments. Steroids or radiation can reduce swelling in a few days to a few weeks. Problems that can be treated with surgery usually do not come back if the surgery is done after your thyroid hormones are under control.

How can I take care of myself?

• Follow your treatment plan.
• Keep all appointments for provider visits or tests.

How can I help prevent thyroid eye disease?

Usually thyroid eye disease cannot be prevented. However, serious problems with your eyes and blindness can be prevented by early diagnosis and treatment. Have regular checkups. Contact your healthcare provider if you develop any symptoms that concern you.