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What Is Thyroid Eye Disease? Causes, Symptoms, and Treatment

Thyroid eye disease is an autoimmune condition that affects your ability to see clearly. It’s closely linked with thyroid gland issues, which can cause a wide range of related health problems.

If you think you’re experiencing thyroid hormone problems, talk to your doctor and visit an ophthalmologist. If you’re still unsure, this article is here to help. Read on to learn everything you need to know about thyroid eye disease (TED), including its causes, symptoms, and treatment options.

What Is Thyroid Eye Disease?

Thyroid eye disease, or Graves’ orbitopathy, causes your immune system to trigger inflammation. As such, it’s considered an autoimmune condition.

This disease causes inflammation and swelling around your eyeballs, specifically the connective tissues and muscles. This inflammation can lead to additional problems like double vision and dry eyes, along with more severe issues like vision loss in some cases.

The main culprit behind thyroid eye disease is Graves’ disease, an autoimmune disorder that affects the thyroid gland and causes the immune system to attack it. However, not every case of thyroid eye disease is caused by Graves’. For example, individuals with normal thyroid function can still develop this condition.

What Are the Causes of Thyroid Eye Disease?

In cases of thyroid eye disease, the body’s immune system mistakenly attacks its own tissues, targeting the eyes and leading to serious symptoms.

We don’t fully understand what causes this condition, but we do know that your family history, hyperthyroidism, hypothyroidism, and your environment can all play a role.

Genetics

First, we know that thyroid eye disease runs in families and that heredity is a risk factor. That’s because specific genes regulate the immune system and thyroid function, which can be passed down through your family tree and cause eye problems down the road.

Hyperthyroidism

Hyperthyroidism and Graves’ disease are the same. In hyperthyroidism, the immune system inadvertently attacks the thyroid, causing the gland to produce too much thyroid hormone. These imbalanced hormone levels affect the tissues around the eyes.

A significant portion of patients with Graves’ disease will develop thyroid eye disease, but the symptoms can range from mild to severe. In some cases, dryness in and around the eyes is the only noticeable symptom, while others might experience significant vision loss.

Hypothyroidism

Some conditions cause your thyroid gland to produce too little thyroid hormone — these diseases can also lead to TED. In addition, individuals with normal thyroid function can sometimes develop TED, but it is relatively rare.

Occasionally, thyroid eye disease develops after treatment for hyperthyroidism, which can bring thyroid function back to normal but still cause various side effects. Treatments like iodine therapy and surgery sometimes have complications that can lead to TED, as well.

Environment and Lifestyle

Certain environmental and lifestyle factors can also increase your risk of developing thyroid eye disease, or they can make your symptoms worse. If you’re already genetically predisposed to develop this condition, your symptoms can be more severe.

Here are two of the biggest triggers:

  • Smoking: Smoking is a major risk factor for TED, especially if you’re a smoker with Graves’ disease. It can also pose an issue if you have another autoimmune disorder or chronic condition.
  • Stress: Stress may also put you at risk of experiencing more severe TED symptoms. Sometimes, stress causes the symptoms of TED to flare up, causing issues like bulging eyes, dryness, and more.

These factors are worth monitoring if you have TED or if the condition runs in your family. In either case, aiming to live a healthy, balanced life is one of the best ways to manage the condition.

What Are the Symptoms of Thyroid Eye Disease?

As you now know, the symptoms of thyroid eye disease can vary from person to person, and their severity can increase and decrease over time.

In general, symptoms usually go through two phases: an active phase and an inactive phase.

Active Phase Symptoms

The active phase of TED can last anywhere from a few months to several years. During this period, eye symptoms tend to be at their worst. They include:

  • Bulging Eyes: Bulging or protruding eyes are often one of the most recognizable symptoms. This issue develops due to inflammation and swelling when the immune system attacks the thyroid gland, causing compression around your eyes and pushing them forward.
  • Eye Pain: In the active phase, TED can be quite painful. Many people affected by TED experience pain and discomfort in their eye sockets, especially when moving their eyes back and forth. Sometimes, a person with TED may feel a gritty sensation behind their eyes, along with pressure and tightness.
  • Dry Eyes: Inflammation from an autoimmune disease like Graves’ can reduce tear production, which in turn can make your eyes red, dry, and irritated. Sometimes, this issue results in watery eyes as the body compensates for the dryness. For milder cases, artificial tears or other eye drops can be helpful.
  • Double Vision: Also known as diplopia, double vision co-occurs with TED due to eye muscle swelling. This swelling can cause misalignments that make it harder to see clearly. Many folks who deal with TED find it especially difficult to read because of this issue.
  • Sensitivity to Light: TED can make your eyes more sensitive to light, causing irritation and dryness in bright environments.
  • Loss of Vision: As antibodies attack and cause inflammation and swelling, the optic nerve in the eye may be damaged, causing lasting vision loss. This issue is most common in severe cases, but vision changes are almost always a symptom of TED.

In addition to these symptoms, some patients experience eyelid retraction — their upper eyelids pull back due to swelling, making their eyes look wider. This issue doesn’t always add to the physical discomfort of TED, but it can affect a person’s confidence and self-esteem.

Inactive Phase Symptoms

During the inactive phase of TED, some of the more painful symptoms caused by inflammation and swelling may subside. However, other symptoms like bulging eyes and double vision often continue to affect a person’s life.

In the inactive phase, treatment usually focuses on helping a person with TED feel confident, comfortable, and able to live unhindered.

How Is Thyroid Eye Disease Treated?

Treatment for Graves’ eye disease often involves treating the thyroid problem at the root of the issue. This might take the form of antithyroid medications or radioactive iodine therapy. Thyroid surgery is also sometimes an option, but it’s typically used as a last resort to control thyroid levels.

Anti-inflammatory medications like corticosteroids and immunosuppressants are often used to treat Graves’ disease and thyroid eye disease. These medications can help manage some of the discomfort and swelling caused by TED, but they often have side effects that must be managed.

In milder cases, lifestyle changes and over-the-counter treatments are the only necessary measures. For example, quitting smoking is a change that eye doctors recommend, along with eye drops, lubricants, or topical ointments to deal with dryness and swelling.

In more extreme cases, eye muscle surgery may be needed to deal with lasting damage caused by TED. However, as with thyroid surgery, this isn’t the first solution an ophthalmologist is likely to recommend.

If you’re unsure how to start managing your TED symptoms, schedule an eye exam and visit your endocrinologist. A clear assessment of your eye and thyroid health can give you a sense of direction for dealing with these uncomfortable symptoms.

Closing Thoughts

Thyroid eye disease can be a life-altering condition, and managing it isn’t always easy. However, there are ways to handle your symptoms, especially when you have the support you need from doctors, friends, and family.

Attending regular eye exams and ordering new glasses when you need them are two of the best ways to stay on top of your symptoms. With the wide selection of Base and Top Frames from Pair, you can look your best while managing your TED symptoms, feeling more confident each and every day.

Check out our full lineup of magnetic Top Frames, which attach seamlessly to your eyeglasses to create a whole new look. With Pair, you can look and feel good, even when you’re dealing with symptoms of TED.

Sources:

Thyroid Eye Disease: What It Is, Symptoms & Treatment | Cleveland Clinic

What Are Common Symptoms of Autoimmune Disease? | Johns Hopkins Medicine

Antibodies: Definition, Types & Function | Cleveland Clinic

Graves' Disease - Symptoms and Causes | Mayo Clinic