Thyroid Eye Disease
What is thyroid eye disease?
Thyroid eye disease (also called Graves' orbitopathy or Graves' eye disease) is an autoimmune condition. The body's immune system attacks the muscles and fat behind the eye, making them swell [1][2].
It is most common in people with an overactive thyroid caused by Graves' disease. It can also happen when thyroid levels are normal or low.
Drawing of a face with both eyes bulging forward and the upper eyelids pulled up, showing white above the coloured part of the eye. Alt text: "Drawing of a person with thyroid eye disease, with bulging eyes and raised upper eyelids that give a staring look."
The disease usually has two stages [2]:
- an active stage, when the eyes are inflamed and changing, often lasting 1 to 2 years
- an inactive stage, when things settle, but some changes (like bulging) may stay
How do I know if I have it?
Signs often affect both eyes, but one may be worse [1][2]:
- Bulging eyes (proptosis)
- Eyelids pulled up, giving a staring look (eyelid retraction)
- Red, gritty, watery or sore eyes, and sensitivity to light
- Puffy eyelids, or an ache behind the eyes
- Double vision, especially when looking up or to the side
- Trouble closing the eyes fully at night
When to get help urgently
Rarely, the swollen tissue squeezes the optic nerve (the nerve of sight), or the eye bulges so much that it cannot close. This can cause permanent loss of vision if not treated quickly [2].
See an eye doctor the same day if you have reduced or blurred vision that does not clear with blinking, colours look faded or washed out, or your eyelids cannot close and the eye is very sore or red. After hours, go to the hospital Emergency Department.
What is the treatment?
Treatment depends on how active and how severe the disease is. You will often be cared for by both an eye specialist and a thyroid specialist [2].
- Mild disease: lubricating eye drops and gel, sunglasses, and sleeping with your head raised. A 6-month course of selenium tablets can help mild, active disease [3].
- Active, moderate to severe disease: steroids, usually given through a drip once a week, or other medicines that calm the immune system [2].
- Double vision: special prism lenses on your glasses can help.
- Later, once the disease is inactive: radiotherapy in some cases, and surgery to reduce bulging (orbital decompression), straighten the eyes, or lower the eyelids [2].
Prevention and getting help
You can lower your risk and help your eyes get better [1][2]:
- Stop smoking. Smoking is the biggest risk you can change. Smokers get more severe disease, and treatment works less well. Stopping at any time helps.
- Keep your thyroid levels stable. Take your thyroid medicines as advised and go for your blood tests.
- If you need radioactive iodine for your thyroid, tell your doctor about your eyes. You may need steroid tablets to protect them.
- Tell your doctor early about any eye changes.
Where to get help in Brunei
If you have thyroid disease and notice eye changes, you can walk in to any Community Eye Clinic at your health centre. No referral is needed.
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References
- NHS. Overactive thyroid (hyperthyroidism). https://www.nhs.uk/conditions/overactive-thyroid-hyperthyroidism/
- Bartalena L, Kahaly GJ, Baldeschi L, et al. The 2021 European Group on Graves' orbitopathy (EUGOGO) clinical practice guidelines for the medical management of Graves' orbitopathy. European Journal of Endocrinology. 2021;185(4):G43–G67. https://doi.org/10.1530/EJE-21-0479
- Marcocci C, Kahaly GJ, Krassas GE, et al. Selenium and the course of mild Graves' orbitopathy. New England Journal of Medicine. 2011;364(20):1920–1931. https://doi.org/10.1056/NEJMoa1012985
This page is for general education and does not replace advice from your own doctor.