Thyroid eye disease

Thyroid eye disease (TED) is an eye condition that causes the muscles and soft tissues in and around your eye socket to swell. It usually happens when you have a problem with your thyroid gland. It may also be called thyroid associated ophthalmopathy (TAO), thyroid orbitopathy, Graves’ orbitopathy or Graves’ ophthalmopathy (GO).

The period of inflammation and swelling caused by TED is known as the "active" stage. This generally resolves on its own over a period of about six months to two years. After this, the inflammation settles, and this is known as the "inactive" or "burnt out" stage.

Our guide to thyroid eye disease covers the condition in more detail. 

Download our guide to thyroid eye disease (Word, 682KB)

How can TED affect my eyes?

The most common way TED affects the eyes is by causing symptoms of dry eye - watering, grittiness, and soreness. You may also find that bright lights are uncomfortable.   

TED can also cause some changes to the appearance of your eyes, and in some cases, to your vision:

  • Your eyelids can become puffy and red (lid swelling), which is often more obvious in the morning.
  • Your upper eyelid can rise to a higher position than normal, known as eyelid retraction. This can make more of the white of your eye visible, giving a "staring" appearance.
  • The soft tissues behind your eyeball can swell, pushing your eyes forward so that they "bulge" (called "exophthalmos", or "proptosis").
  • Your orbits (eye sockets) may become painful, particularly when your eyes move.
  • The muscles that move the eyeball can become swollen which can cause double vision (diplopia).
  • If the pressure inside your eye sockets increases, it can squash (compress) the optic nerve, which can cause blurring or dimming of your vision. Very few people with TED experience this, but it’s important to get medical attention straight away if you notice these changes to your vision.

Most people only get a mild form of TED. You may have dry eye which can be managed easily with lubricating eye drops. You may have some eyelid retraction or exophthalmos and any double vision you have may come and go and not cause too much difficulty. 

Treatment during the active stage

During the active stage of TED treatments are aimed at improving your symptoms and protecting your eyes while the condition runs its course.

Most commonly, this involves treating dry eyes or double vision. Symptoms of dry eye can be managed with artificial tear eye drops, and double vision may be managed with prisms or occlusion (covering one eye). For most people, this is all the treatment they will need at this stage and the condition won’t get any more advanced than this. 

Much less commonly, where your vision is at risk, you may need treatments to avoid damage to your optic nerve. Very few people have TED that progresses to a stage where these treatments are needed.

What can I do to help with the symptoms of TED?

During the active stage of TED, there are some things you can do that might help your symptoms:

  • Sleeping propped up on extra pillows can help reduce the puffiness and congestion around your eyes in the morning.
  • Using artificial tear eye drops and avoiding or protecting your eyes in dusty or windy environments, can help with symptoms of dry eye.
  • Keeping control of your thyroid hormone levels, to help manage your thyroid condition is important.
  • Stopping smoking – smoking can make TED dramatically worse.
  • Taking selenium supplements – this can help some people with mild TED.
  • Wearing sunglasses if you find that bright lights are uncomfortable.

Treatment after TED has burnt out

The swelling caused by TED can often improve once the active stage has passed, meaning there can be some improvement in the appearance of your eyes.

However, some people may be left with some changes caused by the swelling and may need surgery to deal with any remaining double vision, ensure the eyelids are protecting your eyes, and improve the appearance of your eyes.

Often, several surgeries are required to manage the changes caused by TED and may be carried out over about 18 months to two years.

For more information on how TED affects your sight and the available treatments, download our guide (Word document).

Get in touch

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