Thyroid Eye Disease: What Your Eyes Can Tell You About Your Thyroid Health

Thyroid eye disease is a rare autoimmune condition that affects the muscles, fat, and tissue in the compartment surrounding the eyes. Swelling in these tissues pushes the eyes forward and leads to bulging eyes, dry eyes, and vision changes. Thyroid eye disease is usually associated with hyperthyroidism (overactive thyroid). But it can also happen in people with hypothyroidism (underactive thyroid) or even normal thyroid function. 

Read on to find out more about thyroid eye disease and how it’s treated. 

What causes thyroid eye disease?

Thyroid eye disease is caused by the immune system attacking the tissue around the eye. It’s called thyroid eye disease because in most cases, the immune system attacks the thyroid gland at the same time or within a year of when eye symptoms start. 

Autoimmune conditions like thyroid eye disease happen when the immune system makes autoantibodies that incorrectly target healthy tissue. People with thyroid eye disease have autoantibodies that target the tissue around the eyes. 

Thyroid eye disease can develop in people who have autoimmune thyroid diseases, including Graves’ disease and Hashimoto’s thyroiditis.

Graves’ disease

Graves’ disease is the most common cause of thyroid eye disease. That’s why thyroid eye disease is sometimes called thyroid-associated ophthalmopathy or Graves’ orbitopathy. Graves’ disease usually causes hyperthyroidism, or an overproduction of thyroid hormone. Up to half of people with Graves’ disease develop thyroid eye disease. 

Hashimoto’s thyroiditis

People with Hashimoto’s thyroiditis can develop thyroid eye disease too, but this is rare. In Hashimoto’s thyroiditis, autoantibodies targeting the thyroid gland usually cause hypothyroidism, or an underproduction of thyroid hormone. 

What are the symptoms of thyroid eye disease?

Some people with mild thyroid eye disease have no symptoms. Or they may have subtle symptoms like eye irritation and tearing. 

More serious symptoms of thyroid eye disease include:

• Bulging eyes (proptosis): When the immune system attacks the tissues around the eyes, it causes swelling that pushes the eyes forward. This makes the eyes appear to “stick out” from the head. 

• Eyelid retraction: The eyelids pull away from the eye, so that more of the white part of the eye (sclera) is visible.

• Dry eyes: If the eye is protruding and eyelids are retracted, then the eyelids may not completely cover the front of the eye (cornea) when blinking. This can lead to dry eyes, which causes irritated red eyes, tearing, and blurred vision.

• Eyelid swelling: Eyelids can become swollen from inflammation around the eye. 

• Double vision: If the muscles around the eyes become swollen, it’s harder for the eyes to move properly. This can result in double vision.

• Vision loss: Thyroid eye disease can cause optic nerve compression, which damages the optic nerve. The optic nerve connects the eye to the brain and allows people to see. You can develop vision loss when the optic nerve gets compressed. Thyroid eye disease can also cause scarring on the cornea, which can also lead to vision loss. 

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Symptoms of thyroid eye disease can change over time. Sometimes symptoms can get better, and other times they can get worse. Thyroid eye disease usually affects both eyes, but some people may notice worse symptoms in one eye.

How serious is thyroid eye disease?

Thyroid eye disease is a very serious condition. If left untreated, it can lead to permanent vision loss. Swelling of the eye muscles can put pressure on the optic nerve. Damage to the optic nerve can lead to vision loss and loss of color sensitivity. Dry eyes associated with thyroid eye disease can often be painful and lead to blurred vision. 

How do you treat thyroid eye disease?

It’s important to get treatment for your thyroid condition if you have thyroid eye disease. But this is only part of the treatment. You also need separate treatment for your thyroid eye disease. That’s because thyroid eye disease can develop even after your thyroid hormone levels have gone back to normal with medication. 

Thyroid eye disease treatment includes:

• Eye care: People will need treatment with artificial tears to lubricate dry eyes. It’s also important to wear sunglasses with ultraviolet (UV) protection to protect your eyes from UV light damage. You can also try prism glasses if you’re experiencing double vision from thyroid eye disease.

• Smoking cessation: Smoking can make thyroid eye disease worse. Smoking cessation can help you get thyroid eye disease under better control.

• Medications: Tepezza (Teprotumumab) is the first and only FDA-approved prescription treatment for thyroid eye disease. This medication has been shown in studies to reduce the signs and symptoms of thyroid eye disease. Tepezza is administered by a healthcare professional through an infusion into a vein. Treatment requires 8 infusions given 3 weeks apart. Thyroid eye disease can also be treated with corticosteroids to reduce the inflammation around the eye. Usually steroids given intravenously are more effective than steroids taken by mouth. 

• Radiation therapy: Radiation therapy uses strong doses of radiation to reduce inflammation around the eye. Treatment with radiation and steroids together can be more effective than either by itself. 

• Surgery: In some cases, people also need surgery. Orbital decompression surgery creates more space in the orbit by removing portions of the bony walls. This surgery removes pressure on the optic nerve caused by the inflamed tissues around the eye. Eye muscle surgery (strabismus surgery) can be performed once orbital decompression has been performed. This surgery can treat double vision and eye muscle misalignment. Eyelid surgery can also be performed to improve the appearance of the lids and help them to close fully. 

Can thyroid eye disease be cured?

No, there’s no cure for thyroid eye disease. But there are medications and surgical options to reduce symptoms and improve your quality of life. 

Can you prevent thyroid eye disease?

If you have Graves’ disease, you may not be able to prevent thyroid eye disease. But there are things you can do to reduce your chances of developing severe thyroid eye disease. For example, you can do the following:

• Quit smoking. Smoking is the number one risk factor for developing thyroid eye disease or worsening of this condition.

• Get your eyes checked regularly. That way, if you develop thyroid eye disease, it can be identified and treated early.

Why trust our experts?

Written by:

Nishika Reddy, MD

Nishika Reddy, MD, is an attending physician at the University of Utah. She provides comprehensive and cornea medical care at the Moran Eye Center and serves as clinical assistant professor.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

Reviewed by:

Christine Giordano, MD

Christine Giordano, MD, is board-certified in general internal medicine. She received her medical degree from Rutgers New Jersey Medical School and completed residency at Thomas Jefferson University.

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