This condition is usually but not invariably affected by imbalance in the thyroid hormone produced by the thyroid gland, located in the neck. The thyroid hormone helps to regulate our metabolism. 

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

Sometimes this gland can become over or under active, due to malfunction of the body’s immune system. The muscles and other tissues in the skull’s orbits become swollen, causing the eyes to push forward and become unusually prominent. They will often take on a more staring appearance.

Thyroid eye disease (TED)  or Thyroid Associated Orbitopathy (TAO) may indicate its presence through:

  • Swelling of the fatty tissue surrounding the eyes and the muscles that move the eye, causing the eyes to protrude forwards (proptosis). In severe cases, the clear covering of the eye (the cornea) may ulcerate, or the optic nerve may be compressed resulting in loss of vision.
  • Double vision. Swollen muscles may not be able to move the eyes properly, causing double vision. When upper eyelids retract, they cause a staring appearance.
  • Puffy and swollen eyelids.
  • Dry, sore and red eye.


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.