Thyroid Eye Disease - Causes, Symptoms, Diagnosis, Prevention & Treatment

Thyroid Eye Disease

Dr.Santosh Honavar profile Authored by Dr.Santosh Honavar on 12 Jun 2015 - 14:34.


Thyroid Eye Disease (TED) is a medical condition which is known by various names including Grave's Orbitopathy (GO) and Thyroid Associated Ophthalmopathy (TAO).  TED is an autoimmune condition wherein body's own immune system produces antibodies against cells present in the thyroid and eye structures.  It is genetically susceptible. Smoking exacerbates the condition. Occurrence of TED is more common in middle aged individuals especially females. In younger age groups and males, the disease tends to be more severe.





The condition is bilateral, although one eye may be more involved than the other. Signs and symptoms of TED include

  • Foreign body sensation in the eyes
  • Excessive tearing
  • Dryness or grittiness
  • Pain or discomfort at rest and/or with eye movements
  • Redness
  • Swelling around the eyes-puffy eyes
  • Forward protrusion of one or both eyes-bulgy eyes
  • Double vision
  • Blurred vision
  • 'Staring’ or ‘Frightened’ look

There are systemic signs and symptoms which are related to the underlying thyroid disorder including weight gain/loss, fatigue, apathy, intolerance to heat/cold, hair loss, palpitation etc.

Those with thyroid disorders (hyperthyroidism or hypothyroidism) are easily detected to have eye signs and symptoms when present, although it has an almost equal incidence in euthyroid individuals (those with normal thyroid function). Not all patients with thyroid disorder are affected with this condition, since TED and thyroid disorder are independent manifestations of an underlying autoimmune condition. However, treatment of thyroid disorder is necessary to control the eye disease.

Most doctors would advise a thyroid function test and if abnormal, they recommend treatment by an endocrinologist to normalise the thyroid status, and if the patient is a smoker, cessation of smoking is a must. 

Treatment of the eye signs and symptoms will depend on the stage and severity of the disease. TED typically manifests in two stages : Active phase and Stable phase.

Active phase is when there is inflammation in the eyes which causes redness, pain and swelling. This may or may not be associated with double and/or blurred vision. When the vision is affected and there is radiological evidence of optic nerve compromise, an urgent orbital decompression may be necessary, although this is very rare. When there is significant inflammatory activity, the condition is treated with oral or intravenous steroids.

The treatment is tailored to individual patient based on the response to the treatment. Some doctors may advise the use of a special type of glasses (Fresnel prisms) to alleviate double vision while others may recommend Botox. Either treatment can be beneficial. If the disease is not so severe the condition may be treated with just anti-inflammatory drugs. TED can also cause fluctuation in eye pressure (intraocular pressure, IOP) and if necessary, IOP lowering agents may have to be started. Sometimes all it requires is observation.

Stable Phase: An individual is considered to have entered the stable phase when there is no longer any sign of inflammatory activity and the clinical picture has been stable for at least six months.  There is no way of predicting as to when an individual would enter the stable phase. Generally it takes 2-5 years for the disease to settle down, although it could be sooner or later.

The stigma of the active inflammatory disease may vary from malposition of the lids in one or both eyes, cross-eyes to severe bulgy eyes. The goal of treatment in the stable phase is to provide good cosmesis (is the preservation, restoration or bodily beauty) and this is achieved by either Botox or surgery.

Orbital Decompression: For disfiguring bulgy eyes orbital decompression is performed. This involves removal of fat and/or bone to create space for the eyes to be placed back in their normal position. For cross eyes (strabismus or squint) eye muscle surgery is performed to align the eyes.

Lid malposition (retraction): involving upper or lower lid, one or both eyes, may be surgically treated by weakening the lid muscle to bring them back to their normal position and/or achieve symmetry between the eyes. If more than one surgery is required the usual sequence of the procedures is orbital decompression followed by squint correction and lastly, lid surgery. Botox may be used in squint and/or lid malposition but the effect is temporary.


Make sure you follow some prevention measures like:

  • Avoid smoking
  • Control thyroid status 
  • Avoid radio-iodine treatment 


*Disclaimer This is not medical advice. The content is for educational purposes only. Please contact your doctor for any health care issues.