What is Thyroid Eye Disease?

An introduction to thyroid eye disease

Thyroid eye disease (TED) is an auto-immune condition.

Auto-immune means that your own immune system (white blood cells or antibodies) is attacking and causing damage to parts of your body in addition to its normal role of protecting you against infections.

In the case of TED, the damage is directed to fatty tissue and muscles behind the eye causing inflammation. The inflammation may result in the eyes becoming very sore, bloodshot and for uncomfortable swelling to occur above and below the eyes.

The inflammation and swelling of the tissues behind the eyes may also cause the eyes to be pushed forward. This results in what is referred to as the “thyroid stare”, a medical condition called proptosis. The inflammation physically results in dryness of the eyes and may lead to painful ulceration of the cornea which is the transparent covering on the front of the eyes.

In more severe cases, swelling and stiffness of the muscles that move the eye can cause a squint and double vision, especially when you look from side to side. The muscles ultimately become unable to work properly and cannot keep the eyes exactly in line with each other.

As well as being extremely uncomfortable and posing a threat to vision, TED sufferers commonly also undergo psychological trauma due to the very noticeable visible changes that can occur with the disease.

Occasionally, the swelling behind the eyes is bad enough to press on the nerve from the eyes to the brain. This can be dangerous and affect your vision.

The “thyroid stare” known as “proptosis”

Thyroid Eye Disease causing proptosis (‘starey eye’) of the right eye (before orbital decompression surgery)
Improvement in appearance after orbital decompression surgery

What can I do to help improve my thyroid eye disease?

If you are a smoker, it is important to stop smoking. Smoking is a major risk factor for thyroid eye disease. Smoking cessation aids faster recovery from active thyroid eye disease, and outcomes from the medical and surgical treatments are better if you don’t smoke. You should also avoid passive smoking.

Keeping thyroid hormone levels stable is important, as both thyroid overactivity (thyrotoxicosis) and thyroid underactivity (hypothyroidism) are bad for thyroid eye disease. You must regularly monitor thyroid activity with blood tests and ensure that you correctly take antithyroid tablets or thyroxine tablets that your doctor has prescribed. A small minority of people with thyroid eye disease have normal thyroid function and don’t need to take antithyroid tablets or thyroxine tablets.