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

• 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.

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 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.