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Thyroid Eye Disease

Thyroid eye disease, also called Graves’ eye disease or Graves’ orbitopathy, is an autoimmune condition that affects the tissues and muscles around the eye. Thyroid eye disease can occur in up to 50% of people with thyroid disorders. While it most commonly occurs in patients with hyperthyroidism or Graves’ disease, it can also occur in people with underactive thyroid function, called hypothyroidism. 

 

While the exact cause of thyroid eye disease is unknown, we do know it’s an autoimmune condition where people have antibodies in their bloodstream that bind to receptors on the fibroblasts (cells) in the orbit (eye socket). When these antibodies bind to the receptors, it causes inflammation and swelling in and around the eyes, leading to the signs and symptoms of thyroid eye disease.

Leaders in Vision and Eye Care

Houston Methodist is consistently ranked as a national leader in ophthalmology by U.S. News & World Report. Our team of highly trained specialists is comprised of physicians and faculty from Houston Methodist, Weill Cornell Medical College and The University of Texas Medical Branch, bringing together the best doctors, staff and students from locations all over the world. Our ophthalmologists have expertise in all subspecialties of adult ophthalmology, including thyroid eye disease.

Thyroid Eye Disease Symptoms, Risk Factors, Stages & Treatments

Symptoms of Thyroid Eye Disease

Thyroid eye disease symptoms can affect one eye or both eyes. Signs and symptoms of thyroid eye disease can include:

  • Bulging eyes, called proptosis, and sometimes referred to as a “stare”
  • Double vision
  • Dry eyes
  • Red eyes
  • Light sensitivity
  • Foreign body sensation 
  • Pain, pressure or throbbing in the eyes
  • Redness or swelling of the eyelids
  • Trouble closing your eyes completely
  • Watery eyes

Risk Factors for Thyroid Eye Disease

  • Autoimmune disease: The largest risk factor is having an autoimmune condition — 90% of the time it's associated with hyperthyroidism or Graves' disease, but patients can have normal or underactive thyroid function in 5% to 10% of cases. 
  • Family history: If you have a family history of thyroid eye disease, you may be at higher risk of developing the condition as well.
  • Gender: Women are more likely to develop the condition than men.
  • Age: While thyroid eye disease can present at any age, the risk for it increases as you age, with people developing the condition around ages 30 to 40. People may also develop it at ages 60 to 70. 
  • Smoking: Smoking is a significant risk factor. Moreover, smokers who suffer from thyroid eye disease tend to experience more severe symptoms, have a longer disease duration, and may not respond as well to treatment.

Stages of Thyroid Eye Disease

Individuals with thyroid eye disease will experience active and inactive phases with the condition, following a pattern called Rundle’s curve.

 

Once someone develops symptoms, the disease often progresses over a period of one to two years (active phase). The condition will then transition into the chronic, or inactive phase. In the chronic phase, people with thyroid eye disease will often experience some improvement from the active phase. But without treatment, their eyes may not return to their pre-disease state, as the orbital and eyelid tissues will have undergone significant changes due to inflammation.

 

Nonsmokers usually have shorter active phases than those who smoke.

Thyroid Eye Disease Treatment and Procedures

Thyroid eye disease affects each person differently. Some only experience mild symptoms, such as dry eyes, eye puffiness or redness, while others may have severe disease that can cause vision impairment and quality of life issues. Thyroid eye disease treatment is individualized to help ease symptoms and patients’ concerns. 

Medications

Mild thyroid eye disease can be treated with over-the-counter eye drops to ease dryness and irritation. For moderate or severe disease, anti-inflammatory medications, such as steroids, may be prescribed orally or as IV medicines. Immunomodulators, such as rituximab, may be used as well. Teprotumumab is the only FDA-approved medicine for treatment of thyroid eye disease. 

Procedures

Orbital radiation may be an option for people with medication-resistant thyroid eye disease to help reduce swelling and double vision.

Surgery is often used to treat thyroid eye disease, with three procedures most commonly performed:

  • Orbital decompression: Orbital bone and fat behind the eye is removed to create space for the eye to move back into place, or “decompress,” which can decrease eye bulging. 
  • Strabismus surgery: This is a procedure to correct double vision or eye misalignment due to the involvement of the extraocular muscles, the muscles that control the movement of the eyeball within the socket. 
  • Lid retraction repair and eyelid surgery: This surgery weakens the eyelid elevator muscles to decrease eyelid retraction and improve dryness. Blepharoplasty, or eyelid surgery, can be done to remove excess skin and fat from the upper and lower eyelids.

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