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. TED usually happens when you have a problem with your thyroid gland.

TED 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.

This page contains a summary of our information on TED. To read our full information, download our factsheet:

Download our thyroid eye disease factsheet in Word

Can you help improve our information on thyroid eye disease?

We would like your views on our information about thyroid eye disease. Your views will help us make our information as useful as possible for other people diagnosed with this condition. We’re looking for people:

who live in the UK, and
who have been diagnosed with thyroid eye disease or have had thyroid eye disease in the past.

We would like to hear from you if you are willing to answer a few questions (either over the phone or by email) about what information would have been most helpful to you when you were diagnosed with this eye condition. In addition, we’d like to hear your suggestions on how our current information could be improved.

To find out more please contact the RNIB Eye Health Information team on 020 7391 3299 or by email [email protected].

Quick links
– How can TED affect my eyes?
– Treatment during the active stage
– What can I do to help with the symptoms of TED?
– Treatment after TED has burnt out
– Helpful organisations

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 full guide.

Helpful organisations

The Thyroid Eye Disease Charitable Trust (TEDct) can provide information, care and support to those affected by thyroid eye disease.
The British Thyroid Foundation provides information and support for people with any kind of thyroid problem, and their families.