Thyroid-eye disease (TED)  also known as Graves’ Orbitopathy, is an autoimmune inflammatory disorder causing swelling of the tissues around the eyes and  within the eye socket.

Thyroid-eye disease (TED), also known as Graves’ Orbitopathy, is an autoimmune inflammatory disorder causing swelling of the tissues around the eyes and within the eye socket.

The socket is like a bony box containing the eyeball, muscles that move the eye and fat. The inflammation causes a volume increase in the confined space of the eye socket. This can cause the eyes to bulge forwards, producing a staring appearance and the inflamed muscles that are attached to the eyes to move irregularly causing double vision.  In the most severe cases the volume increase can cause the cornea (clear surface of the eye) to break down as the eyelid fails to close properly or compress the optic nerve at the back of the eye leading to loss of vision.

What causes thyroid eye disease?

TED is usually associated with Graves’ Disease, an auto-immune condition that causes over-activity of the thyroid gland. The thyroid gland is located in the neck area and normally determines the metabolism of the body through the secretion of thyroid hormones. However, this condition can be occasionally associated with an under active thyroid.  About 1 in 10 patients never have any thyroid hormone problems.  In 3 out of 4 patients the eye disease starts in the same year as the over (or under) active thyroid and can come on suddenly or more slowly.  Smoking increases the risks of developing eye disease, more severe disease and having a poorer response to treatment. The cause is due to auto immune antibodies that affect both the thyroid and the structures of the eye socket.  

What are the symptoms of thyroid eye disease?

All patients with overactive thyroid from Graves’ disease should be alert to the symptoms of eye disease.  Early warning signs may include:  redness in the eyes or eyelids, swelling or feeling of fullness in one or both upper eyelids, bags under the eyes, eyes that seem to be too wide open, pain in or behind the eyes, gritty eyes with sensitivity to light, and blurred vision or double vision. If a patient experiences one or several of the following symptoms they should seek referral to an thyroid eye specialist, who works closely with the endocrinologist and other specialists managing this condition in a multi-disciplinary approach to ensure patients have access to the most appropriate expertise.

Treatment

The thyroid dysfunction must be investigated, monitored and appropriately treated by an endocrinologist.The eye disease may or may not settle after the thyroid function is normalized. Many patients have to undergo special imaging tests – usually an MRI scan of the eye sockets to fully assess the eye disease.  It is also very important to stop smoking. Taking Selenium supplements for 6 months have been shown  to be of benefit for some patients with mild disease. If there is any sight-threatening problems or  disabling double vision this needs to be treated rapidly to prevent permanent visual problems. This usually involves giving some form of systemic steroid treatment, and sometimes followed by other treatment to settle down the inflammation.

There are a variety of treatments which can be undertaken by an eyelid specialist, both to treat the dry eye problems and to treat the cosmetic deformity caused by thyroid disease. 

This may include steroid injections, systemic steroids, orbital decompression surgery to stop visual loss and to reposition the protruded eyeballs back into the eye sockets, eye muscle (strabismus) surgery to correct double vision and eyelid surgery for treating the raised eyelids and the swelling.

All treatment is preceded by a detailed consultation and examination to establish the correct diagnosis.