There are many different names you might find for the autoimmune eye condition that is often seen with thyroid disease, including:
- Thyroid Eye Disease, sometimes abbreviated as TED
- Graves’ Opthamolopathy
- Thyroid-associated orbitopathy (TAO)
- Grave’s orbitopathy
Thyroid Eye Disease is an autoimmune eye condition that, while separate from thyroid disease, is often seen in conjunction with Graves’ Disease. The condition, however, is seen in people with no other evidence of thyroid dysfunction, and occasionally in patients who have Hashimoto’s Disease. Most thyroid patients, however, will not develop thyroid eye disease, and if so, only mildly so.
Signs and Symptoms of Thyroid Eye Disease
- Pain in the eyes, pain when looking up, down or sideways
- Dryness, itching, dry eyes, difficulty wearing contact lenses
- Inflammation and swelling of the eye, and its surrounding tissues
- Swelling in the orbital tissues which causes the eye to be pushed forward — referred to as exophthalmos — which can make Thyroid Eye Disease sufferers appear to have a wide-eyed or bulging stare.
- Bloodshot appearance to eyes
- Double vision (doctors call it diplopia)
- Impaired vision
Thyroid Eye Disease is known to go through varying degrees of severity, and can go into periods of remission as well. When it has been inactive for a period of around a half a year, it’s less likely to recur.
Smoking and Thyroid Eye Disease
It has been noted that the eye disease develops more frequently and is more severe among women who smoke.
Smokers are twice as likely as nonsmokers to develop Graves’ disease. Smoking also apparently worsens eye problems in people with Graves’ disease.
Smoking also reduces the effectiveness of treatments for thyroid eye disease.
In milder cases of Thyroid Eye Disease, often all that is needed is lubricating eye drops or ointments for moisture, wraparound sunglasses to avoid glare, bedroom humidifiers to reduce dry eye problems. When double vision occurs, some patients respond to the addition or prism lenses in their eyeglasses. For pain, swelling and redness, short courses of the steroids are sometimes prescribed. Symptoms often return after the course of prednisone therapy, however.
Some doctors recommend orbital radiation, which can be successful in some patients.
In rare cases, when medical treatment has not resolved the retracted and puffy eyelids, or double vision, doctors will recommend corrective surgery.
Eyelid surgery is primarily cosmetic in nature, and is designed to bring the eyelids into a more normal position, to improve appearance.
Surgery for double vision works with the muscles that control eye movement.
In a very small percentage of patients, the swelling in the orbital area impairs vision by pressing on the optic nerve. In these cases, a surgery called orbital decompression is needed in order to prevent severe complications.
Definitive therapy is suggested in form of surgery of thyroid gland or radioiodine therapy. Both procedures have their merits and demerits. Surgery is beneficial in terms that it offers a permanent cure and there is no worsening of eye features after surgery. However, there are chances of worsening of eye symptoms when radioiodine is being used as a definitive treatment.