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.

A staring appearance caused by upper eyelid retraction
After eyelid lowering surgery

Because the socket is like a bony box this increase in the volume of the contents can cause the eyes to bulge forwards, producing a staring appearance and the muscles that are attached to the eyes to move irregularly causing double vision. In the most severe cases it can cause the cornea (clear surface of the eye) to break down  or press on the optic nerve causing loss of vision.

What causes thyroid eye disease?

TED is usually caused Graves’ disease, a condition that causes over-activity of the thyroid gland, located in the neck area, which normally determines the metabolism of the body. Patients with this condition have  a 1 in 5 risk of developing eye disease. However, this condition can be occasionally associated 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?

It is encouraged that all patients with overactive thyroids from Grave’s 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 oculoplastic surgeon (eye -doctor with a specialist interest in thyroid eye disease)


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 normalised. The main priority is to treat any sight-threatening disease as well as disabling double vision.

Then 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 orbital decompression surgery 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.


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