Thyroid Eye Disease Center
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The eye changes associated with thyroid disease are referred to as Thyroid Eye Disease . Your doctor may also use the term Thyroid Associated Orbitopathy . Although TED is seen in all types of thyroid disorders, it is most common in patients that are or were hyperthyroid. It also rarely occurs in those who are hypothyroid and even when there is an absence of thyroid abnormalities in the body.
Thyroid disease can cause multiple eye problems. These include redness and swelling, double vision, decreased vision, eyelid retraction , and a bulging of the eye itself. It is important to realize that if one of these occurs, it does not mean you will necessarily get all the other symptoms too.
Eye problems will usually occur and frequently change in type or severity for between six months and two years. Once stabilized, it is unusual for the eyes to start changing again. Some patients are left with permanent changes, and in others the eyes return to normal. A great deal can be done to improve these conditions with medical treatment, although some patients will need surgery to help ease their issues.
Bulging Eyes And Other Thyroid Eye Disease Symptoms
Thyroid Eye Disease can cause a number of different symptoms. You may notice that some symptoms develop slowly and others appear quickly.
Once TED reaches the “chronic” phase, scar tissue that started to form during the “acute” phase can leave you with ongoing symptoms like eye bulging, eye pain, double vision, and pressure. So, it is important to recognize symptoms early and start a treatment plan with your doctor. The sooner you spot changes to your eyes, the sooner your doctor can help.
The Eye Specialist Role
Your specialist can provide simple solutions to the irritation, tearing and swelling often associated with TED. Often, this involves something as simple as using artificial tears during the day and lubrication ointment at night. Your specialist can determine when your eyes have stopped changing and whether corrective surgery is needed. Your specialist may also watch for the rare serious problems associated with TED that need prompt treatment.
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Fact: Ted Is A Different Condition From Graves Disease
Many people think Graves disease and Thyroid Eye Disease are the same. Thats because people often have both diseases at the same time.
That is also because both are autoimmune diseases. This means your bodys immune system attacks a healthy part of your body by mistake.
If you have Graves disease, your bodys immune system attacks the thyroid. If you have TED, your bodys immune system attacks the tissue behind your eyes. This can cause a number of different changes to your eyes.
TED is often called by different names containing the word Graves or thyroid, including:
- Graves eye disease
What Tests Will Be Done To Diagnose Thyroid Eye Disease
A healthcare provider will be able to diagnose thyroid eye disease by doing a physical eye exam. They will be able to examine both your eyelids and your eyes.
If your healthcare provider thinks that you have thyroid eye disease, theyll order blood tests to check if your thyroid hormone levels and antibodies are too high or too low.
Other tests your provider may request include:
- Ultrasound of the eyes.
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You May Notice The Following Appearance And Vision Changes:
- Misaligned eyes or eyes that dont work together
- Sensitivity to light
- Eye pain and pressure
The changes caused by TED may also affect your emotions, making you feel anxious or depressed.
Learn more about the symptoms and signs of TED as well as the impact it can have on your emotional well-being.
While the length of the acute phase of TED is different for everyone, it usually lasts between 6 months to 3 years. During this time, symptoms can change or continue to get worse. Ideally, treatment should be given during the acute phase.
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Patient Photos Of Chronic Thyroid Eye Disease Before And After Tepezza Treatment
Below are some photos that doctors have taken of real patients with chronic TED before TEPEZZA and after 8 infusions. Individual results may vary.
Before TEPEZZA
Real patient treated with TEPEZZA. Individual results may vary.
Before receiving TEPEZZA, this patient had multiple surgeries, including:
- A thyroidectomy
- Lower lid retraction repair surgeries
- Surgery to restore the appearance of her face and eyes
Despite these treatments and surgery, the patient still had eye bulging before TEPEZZA.
Before TEPEZZA
Real patient treated with TEPEZZA. Individual results may vary.
Before receiving TEPEZZA, this patient was treated with:
- Steroids taken by mouth
- Steroid injections
- Surgery to reduce eye bulging
Despite these treatments and surgery, the patient still had double vision and eye bulging before TEPEZZA.
See more real patient photos
See how TEPEZZA helped real patients reduce eye bulging and improve physical appearance.
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Fact: Thyroid Conditions And Ted Need To Be Treated By Different Doctors You Should See An Endocrinologist For Graves Disease Or Other Thyroid Conditions And A Ted Specialist For Ted
Graves disease and Thyroid Eye Disease affect different parts of the body. Graves disease affects the thyroid and should be managed by an endocrinologist, who is an expert in treating thyroid issues.
TED is a separate disease that affects the eyes and should be managed by a doctor experienced in treating it: a TED Specialist. There are a few different types of eye doctors who can be TED Specialists.
If you have both conditions, your endocrinologist and your TED Specialist should stay in regular contact with each other. They need to work together to make the best treatment plan for you.
If you suspect you may have Thyroid Eye Disease, see a TED Specialist and ask for a baseline eye exam.
Why Choose Bascom Palmer Eye Institute
Ranked #1 by U.S. News & World Report. Bascom Palmer Eye Institute, part of the University of Miami Health System, the top-rated hospital in the country for the treatment of diseases and disorders of the eye, according to U.S. News & World Report. When you choose us for your eye care, you will receive the best care in the nation in a compassionate setting.
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How Is Thyroid Eye Disease Treated
Your provider will begin by treating you for thyroid disease if you have it. Treating thyroid diseases doesnt treat thyroid eye disease, so your provider may suggest one or more of these therapies:
Over-the-counter medications to treat TED
Eye drops to relieve dryness and irritation are generally non-prescription. You can buy them over the counter. You should use the drops that lubricate but avoid those that take away redness.
Your provider may also suggest selenium supplements if your blood levels of this mineral are low.
A few studies have shown that drinking aloe vera juice reduced inflammation levels in some cases.
Prescription medications to treat TED
Your provider may prescribe anti-inflammatory drugs like prednisone and other systemic steroids and/or rituximab. Discuss the side effects of these treatments with your provider.
Theres also a new medicine available only for thyroid eye disease called teprotumumab .
Lifestyle changes and home remedies to treat TED
The most important lifestyle change you can make is to quit smoking if you smoke. It raises your risk of developing TED by seven to eight times and makes TEDs active disease phase longer. In addition, smoking decreases the effectiveness of treatment for thyroid eye disease. Other things you can do to be more comfortable include:
Surgery to treat TED
Radiation to treat TED
Your provider may suggest radiation therapy to treat the inflammation of thyroid eye disease.
Treatment Of Thyroid Eye Disease
For a mild case, use lubricating eye drops and artificial tears a few times during the day. Avoid wind and bright light.
If you have severe symptoms, your healthcare provider may prescribe corticosteroids such as prednisone to reduce swelling. In a very small percentage of patients, orbital decompression surgery may be recommended.
This procedure removes the bone between the eye socket and the air sinus behind it so your eye has more room. This can improve your vision but there is a risk of double vision.
Double vision can also occur when scar tissue from the ophthalmopathy makes an eye muscle too short. Eye muscle surgery can be used to attach the muscle at a point where it will again be the correct length to provide single vision. However, more than one surgery may be needed to be successful.
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Whats The Treatment For Graves Eye Disease
If you have Graves disease, youll need treatment for your thyroid problems. Sometimes thyroid treatments help with Graves eye disease but people often need separate treatments for their eye problems.
Over-the-counter eye drops. The most common treatment for dry or irritated eyes is a type of eye drops called artificial tears. You can get these without a prescription. There are also over-the-counter gels and ointments that may help your eyes feel better.
Prescription medicines. If you have a lot of swelling behind your eyes, your doctor may prescribe steroids or other medicines to help reduce swelling. Your doctor may also recommend a new medicine just for Graves eye disease called Tepezza .
Quitting smoking. Smoking makes Graves eye disease worse so quitting smoking is the most important lifestyle change you can make if you have this disease.If you smoke, make a plan to quit.
Other lifestyle changes. You can take steps to ease some common symptoms of Graves eye disease.
- If your eyes are sensitive to light, try using over-the-counter eye drops and wearing sunglasses when you go outside
- If you have puffy eyelids, try raising the head of your bed so your head is higher than your body while you sleep
- If your eyelids dont close all the way, try taping them shut at night to prevent dry eye
Eyeglasses. If you have double vision, special prescription lenses can help fix double vision and help you see more clearly.
October 13, 2022
Deterrence And Patient Education
All patients with thyroid disorders should be routinely screened for early signs of thyroid eye disease. Regular follow-up of asymptomatic GD and mild TED cases can help prompt diagnosis and management of sight-threatening complications. The patients should be explained the early signs of DON â altered color vision, diminished contrast sensitivity, decreased field of vision, and decreased visual acuity.
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What Are The Signs And Symptoms Of Thyroid Eye Disease
The signs and symptoms of thyroid eye disease include:
- Pain behind your eyes and pain with eye movements.
Symptoms normally affect both eyes, but sometimes you may only notice symptoms in one eye.
Is thyroid eye disease contagious?
No. Thyroid eye disease isnt contagious. You cant catch it from anyone, and you cant transmit it to anyone.
Fact: If You Have Ted You Should See An Ophthalmologist Who Has Experience Treating Ted
Thyroid Eye Disease is a unique and rare eye condition, and not all doctors are used to treating it. Thats why its important that you see a doctor who has the right experiencea TED Specialist.
TED Specialists are ophthalmologists who usually have advanced training, such as oculoplastic surgeons, neuro- ophthalmologists, and strabismus surgeons.
While there are about 20,000 eye doctors in the US, most are not used to seeing TED patients. TED Specialists have advanced training in specific types of eye and vision care.
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In July 2020 I Flew Out To California To Have Surgery On Both Of My Eyes
I chose to have corrective surgery because I wanted to recognize myself in the mirror again. To give my eyes back their normal position and shape, I had orbital decompression surgery on both eyes, lower and upper lid repair, and buccal fat removal from both sides of my face. Currently, Im still healing from surgery, and it can take up to three months to see end results. But already, I can see myself in the mirror instead of someone I dont recognize.
This experience taught me that its important to advocate for yourself. If doctors tell you theres nothing that can be done to help you and you know something is wrong, do your research and find someone else. Look for a doctor who is willing to listen to you and understand what youre going through. They are out there.
Causes Of Bulging Eyes
A common cause of bulging eyes is an overactive thyroid gland .
This is where the thyroid gland , produces too much of the thyroid hormones.
Less common causes of bulging eyes include:
- an infection or injury around or behind your eyes
- bleeding behind the eyes or problems with blood vessels behind the eyes
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Who Is In That Photo
It only got worse as my symptoms progressed. I hated how I looked in photos, and I often didnt recognize myself – it must be someone else in my clothes, standing with my friends, staring into the camera lens with those wide red eyes that werent mine, masquerading as me. I found that I couldnt casually smile for the camera! I had no idea how the photo would come out, and it never seemed to make me happy. I eventually found one angle that I didnt completely despise, but wearing sunglasses in photos became an easier solution compared to risking a pose and finding out how it went when it was posted on social media for all to see.
Impact Of Thyroid Eye Disease And Photos
I think its hard for loved ones to grasp just how impactful not recognizing yourself in pictures is and how damaging it can be to self-esteem and mental health. Comments like Were your friends, we dont care what you look like! and Youll have surgery and everything will be fine! though well-intended felt dismissive and diminished the true emotional trauma I was going through. But on two occasions I felt seen. Oh lets take a fun group photo with sunglasses! She looked at me, leaned in, and whispered, Is that okay? Ive been listening. And a tear came to my eye. I eventually came to accept that it was okay to not take pictures for a while. It was better for my mental health and overall well-being, though I was always game for group sunglass photos.
Im happy to say that I finally had orbital decompression surgery a few weeks ago. As I wait for the internal swelling to go down and for my upcoming lid surgery, I cant help but have a million questions â What will my eyes look like? I know it wont be exactly the same as it was before, but will I look more like me? Will I have to re-learn how to tilt my head and smile for the camera? Will I feel comfortable in photos again? I have hope.
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Fact: The Sooner Ted Is Treated The Better Ted May Cause Serious Eye Damage
Thyroid Eye Disease is an ongoing condition with 2 phases. If left untreated, TED may get worse over time.
Phase 1: Acute TED During the acute phase, symptoms appear suddenly and can get worse quickly. Inflammation and scarring can start to damage your eyes. Because of this damage, you may notice symptoms like eye pain, redness, swelling, eye bulging, double vision, and misaligned eyes. The acute phase usually lasts between 6 months to 3 years.
Phase 2: Chronic TED Over time, TED changes to the chronic phase where scarring and damage continue. During this phase, some symptoms may get betterlike redness and swelling. But others may not go awaylike eye bulging, double vision, misaligned eyes and eye pain. If left untreated, some symptoms may return, or flare up.
Spot TED symptoms, avoid serious damage
Keeping track of your symptomsand talking with your doctor right away about any changescan have a big impact. Speak up for the care you deserve.
Other Potential Symptoms Of Thyroid Eye Disease To Look For
TED affects everyone differently. You may experience all or some of the symptoms listed below. After reading about the symptoms of TED, you can use the interactive tool Talking to Your Doctor about TED to help you prepare for your next appointment with your doctor.
Dry, gritty eyes
- Eyes feel dry and gritty
- This may make it feel like theres something in your eye, like sand
Swollen, puffy eyelids
- Eyelids look red and swollen
- Your doctor may call this eyelid edema
Watery, teary eyes
- Eyes are constantly watery, when not crying
- This can make it hard to see clearly because of extra fluid
Red, swollen eyes
- Eyes appear red, bloodshot, and swollen
- Your doctor may call this erythema or chemosis
- This is sometimes confused with allergies or an infection
Light sensitivity
- Eyes may become sensitive to light
Eye pain or eye pressure
- Pain may be felt in, around, and behind the eyes, and when moving the eyes
- Pressure may be felt behind or around the eyes, which can lead to headaches
Misaligned eyes
- Eyes look crossed or misaligned
- This can lead to double vision
- Your doctor may call this strabismus
Blurry vision
- Vision becomes out of focus or blurry
Pulled-back eyelids, also called eyelid retraction
- Eyelids are pulled back
- This may cause a constant stare or wide-eyed appearance
- It may also make it hard to close your eyes
- To sleep, your eyes may need to be taped shut
- This can expose more of the eye than normal which can lead to other symptoms like dry eyes
Double vision
Vision loss
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An Intelligent Diagnostic System For Thyroid
- 1Department of Ophthalmology, Changzheng Hospital, Naval Medical University, Shanghai, China
- 2Airdoc LLC, Beijing, China
- 3Faculty of Engineering, Monash University, Clayton, VIC, Australia
- 4Department of Ophthalmology, Naval Medical Center of the Peoples Liberation Army, Naval Medical University, Shanghai, China
- 5The Laboratory of Artificial Intelligence and Bigdata in Ophthalmology, The Affiliated Eye Hospital of Nanjing Medical University, Nanjing, China
Background: Thyroid-associated ophthalmopathy is one of the most common orbital diseases that seriously threatens visual function and significantly affects patients appearances, rendering them unable to work. This study established an intelligent diagnostic system for TAO based on facial images.
Methods: Patient images and data were obtained from medical records of patients with TAO who visited Shanghai Changzheng Hospital from 2013 to 2018. Eyelid retraction, ocular dyskinesia, conjunctival congestion, and other signs were noted on the images. Patients were classified according to the types, stages, and grades of TAO based on the diagnostic criteria. The diagnostic system consisted of multiple task-specific models.
Results: The intelligent diagnostic system accurately diagnosed TAO in three stages. The built-in models pre-processed the facial images and diagnosed multiple TAO signs, with average areas under the receiver operating characteristic curves exceeding 0.85 .