Thyroid Eye Disease

Thyroid Eye Disease (TED)


Can thyroid affect the eyes ?

YES. It can cause a variety of problems ranging from simple redness and gritty ness of eyes to blindness. It is important for everyone having thyroid disease to be vigilant of this and be under the watchful eye of see an Oculoplastic specialist at the earliest. There is now a lot that can be done to help people with TED, from artificial tear drops to surgery.

What is Thyroid Eye Disease (TED)?

Thyroid eye disease (TED) is an eye condition in which the eye muscles and fatty tissue behind the eye become inflamed. This can cause the eyes to be pushed forward (‘staring’ or ‘bulging’ eyes) and the eyes and eyelids to become swollen and red. In some cases there is swelling and stiffness of the muscles that move the eyes so that the eyes are no longer in line with each other; this can cause double vision. Rarely TED can cause blindness from pressure on the nerve at the back of the eye or ulcers forming on the front of the eyes.

What is the chance that I will develop TED?

TED is mainly associated with an over-active thyroid due to Graves’ disease, although it does sometimes occur in people with an under-active or normally functioning thyroid. Overall, about 25% of people with Graves’ disease develop TED either before, during, or after their thyroid disorder is diagnosed. In most cases the eye disease is mild. Smoking increases the chances of developing TED eight times as compared to non-smokers.

What are the symptoms of TED?

These are the most common symptoms. See an Oculoplastic specialist if you experience any of the following:

  • Change in the appearance of the eyes (usually staring or bulging eyes)
  • Gritty feeling in the eyes
  • Dry or watery eyes
  • Discomfort in bright lights
  • Swelling or feeling of fullness in one or both upper eyelids
  • Bags under the eyes
  • Redness of the lids and eyes
  • Blurred or double vision
  • Pain in or behind the eye
  • Difficulty moving the eyes

TED can sometimes be difficult to diagnose and patients may be treated for conjunctivitis, allergy or hay-fever for months before the diagnosis is made.

What is the usual course of the disease?

Thyroid affecting the eyes may be akinned to a city experiencing an earthquake. There are 2 phases,

1. The active phase- akin to the short duration while the earthquake occurs, causing maximum destruction. This phase can last anywhere between 6-24 months. In this phase, the inflammation is active, and early intervention in this phase can limit the permanent effects on the eyes.

2. The inactive phase- akin to the aftermath of the earthquake, which is the resultant permanent damage to the city. In the inactive phase, treatment is directed at dealing with the permanent changes.

Can I do anything to prevent TED from getting worse?

Three things you can do are:

  • If you are smoker, give it up -Smoking is the single most important modifiable risk factor for TED. Non smokers or those who have stopped smoking respond better to treatments
  • Avoid fluctuations in your thyroid levels
  • Selenium supplements - evidence suggests that patients with mild active TED may benefit from a six month course of selenium supplements at a dose of 100mcg twice daily.

Can TED affect my quality of life?

Yes, TED can affect your psychological and social well-being. Especially with fluctuating thyroid levels, you may feel anxious and/or irritable and suffer from mood swings until your hormone levels are stabilised. You may also feel anger, loss of self-esteem or confidence, or socially isolated, because of the change in the appearance of your eyes.

What treatments are available for people with TED?

Treatment depends on

  • the severity of TED
  • the stage of TED: whether TED is active or inactive
In Active TED:
  • Mild cases: if your eyes feel gritty, water a lot and feel uncomfortable in bright lights, then artificial tear drops will help your eyes feel more comfortable. Selenium supplements (100mcg twice daily for six months) are also beneficial.
  • In More severe cases: treatment with steroids, steroid sparing agents, or radiotherapy may be considered. Rarely decompression surgery may be done in an emergency to save the vision, if there is inadvertent pressure of stretch on the nerve. Prisms may be used to manage double vision.

In Inactive TED:

Unfortunately, many people with TED are left with a permanent change, usually in the physical appearance of their eyes or sometimes double vision. Rehabilitative surgery may involve:

  • Decompression surgery to create space behind the eyes when there is a lot of protrusion of the eyeballs, in order to improve a person’s appearance
  • Eye muscle surgery to treat double vision
  • Eyelid surgery to improve the appearance of the eyelids

What should I do if the symptoms get worse?

In less than 5% of people TED becomes very severe. You might experience disabling double vision; the ‘cornea’/ front of the eye can develop ulcers and interfere with vision; and rarely, the ‘optic nerve’ carrying messages to the brain can be compressed, leading to loss of vision. If complications are diagnosed early the treatment can still be successful.

You should see an Oculoplastic specialist without delay if:

  • Your symptoms get increasingly worse over a period of several days or weeks
  • You have blurred vision which does not improve by blinking or covering each of the two eyes in turn
  • You become aware that colours do not appear as bright as they used to, or there is a difference in how bright colours seem when you compare one eye with the other
  • You see double
  • You experience severe pain and watering of eyes
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