Treatment Options for Thyroid Eye Disease

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If you have Graves’ disease, an autoimmune disorder that causes your thyroid to make too much thyroid hormone, you’re probably familiar with symptoms like anxiety, irritability, weight loss, and fatigue–but it’s also important to be aware of a common complication of Graves’ disease, called thyroid eye disease or Graves’ ophthalmopathy.

Unfortunately, the same autoimmune process that causes your immune system to mistakenly attack your thyroid gland with Graves’ disease can also lead to inflammation and swelling of the muscles, fat, and connective tissue around your eyes. It’s estimated between one-third to one-half of people with Graves’ disease will develop thyroid eye disease. If you fall into this group, your treatment options will depend on the severity and the current state of your disease. No matter what, there are effective therapies available to ease symptoms and prevent thyroid eye disease from worsening.

Treating Thyroid Eye Disease

If you have hyperthyroidism due to Graves’ disease, be on the lookout for symptoms like eye redness, bulging eyes, double vision, light sensitivity, dry eyes, eye pain and pressure, decreased vision, swollen or retracted eyelids, or feeling like there’s something stuck in your eye. If you notice any of these signs, reach out to your doctor as soon as possible to determine if it’s thyroid eye disease. Treating your underlying Graves’ disease doesn’t always completely resolve thyroid eye disease, so you’ll work with your doctor to decide upon the right treatment to relieve eye symptoms.

There are usually two phases of thyroid eye disease: active and stable. You should be closely monitored during the active phase, which can last from 6 months to 2 years. During this time, treatment focuses on managing your symptoms and relieving inflammation in order to stabilize the progression of the disease. Your doctor may suggest:

  • Selenium: This mineral, found in nuts, fish, meat, grains, and dairy products, works as an antioxidant to keep cells healthy. It also plays a crucial role in helping your thyroid function well, so it makes sense there’s a link between selenium deficiency and the development of thyroid eye disease. Treatment with an oral supplement of this mineral may help, although consuming it via food can also be a good strategy.

  • Steroids: Steroids, like prednisone, may be taken by mouth for a few weeks. For more severe cases, steroids can also be given through an IV or even injected directly into your eye. Steroids can reduce inflammation and the uncomfortable symptoms associated with thyroid eye disease. They are generally used for short-term periods due to side effects like mood swings, difficulty sleeping, increased appetite, weight gain, muscle weakness, and others.

  • Biologic and immune-suppressing drugs: If you don’t respond to or can’t tolerate steroids, medications like rituximab, cyclosporine, and methotrexate may be used. These therapies suppress your immune system’s functioning and have been successfully used to treat other autoimmune diseases, especially when it comes to decreasing inflammation. Newer biologics, such as teprotumumab, are derived from living organisms and show exciting promise for improving the eye bulging, swelling, and pain associated with thyroid eye disease.

  • Radiation: In some cases, radiation of the orbit (eye socket) may be used along with steroids to reduce swelling.

  • Prisms: Your eye doctor can prescribe eyeglass lenses with prisms if you’re suffering from double vision. These lenses bend and redirect light before it travels through the eye so it is processed correctly by your brain, giving you one clear picture instead of two separate images.

If surgery is needed, it’s usually reserved for the stable phase of thyroid eye disease, when the inflammation in your eyes will have subsided. Surgical procedures include:

  • Eyelid surgery: If your eyelids continue to retract and are unable to fully close, you may still experience dryness and irritation. An operation may be performed to reposition or lengthen your eyelids.

  • Strabismus correction: Graves’ disease can cause scar tissue to develop in your eye muscles, resulting in crossed eyes, loss of motility, and double vision. Surgery to modify the affected eye muscles can be used to correct this.

  • Orbital decompression: This procedure is used to relieve pressure on your optic nerve by removing a small piece of bone from your eye socket. It can protect your vision and help with your overall eye comfort.

Lifestyle Changes to Treat Thyroid Eye Disease

It’s important to see your doctor to treat thyroid eye disease, but there are additional things you can try at home to soothe your symptoms, including:

  • Use cool compresses and lubricating drops or ointments, preferably without preservatives or “redness remover” ingredients, to manage dry and irritated eyes.

  • Wear sunglasses to protect your eyes from light and wind.

  • Limit your sodium intake and sleep with your head elevated to help with swelling around your eyes.

  • Try over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen if you are experiencing eye pain.

  • If you smoke, talk to your doctor about quitting. Studies show smoking can worsen the symptoms of Graves’ disease and thyroid eye disease.

Thyroid eye disease can be uncomfortable, but it can be managed with the right tools. If you have Graves’ disease and begin to develop new or worsening eye symptoms, be sure to let your doctor know so you can get started on the right treatment.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Oct 31
  1. Current and Emerging Treatment Strategies for Graves' Orbitopathy. Drugs.
  2. Efficacy and Safety of Immunosuppressive Agents for Thyroid Eye Disease. Ophthalmic Plastic and Reconstructive Surgery.
  3. Graves’ Disease. Mayo Clinic.
  4. Graves’ Eye Disease. American Thyroid Association.
  5. Graves' Eye Disease (Graves' Ophthalmopathy). Harvard Health Publishing.
  6. Thyroid Eye Disease. University of Iowa Department of Ophthalmology and Visual Science.
  7. Thyroid Eye Disease (TED or Graves Eye Disease). Kellogg Eye Center University of Michigan.
  8. What Is Prism Correction in Eyeglasses? American Academy of Ophthalmology.
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