Understanding Thyroid Eye Disease and Its Treatments

Eyes are vulnerable organs. Along with outside physical threats, many health conditions can damage them and cause vision loss. But did you know your eyes can be affected by irregularities with thyroid hormones?

That’s right, even the small gland in your throat can cause severe eye issues. About a half million Americans deal with thyroid eye disease (TED), which stems from the more overarching condition of thyroid disease.

Thyroid Eye Disease (TED)

TED is often the result of Graves’ disease, an autoimmune disorder where the immune system attacks healthy tissue by mistake, leading to the overproduction of thyroid hormones. 

Graves’ disease is the most common form of hyperthyroidism, and about a quarter of patients also suffer from TED. Someone with Graves’ disease may get TED when there is inflammation and damage to muscles and tissues around the eye.

With TED, inflammation often pushes eyes forward, making them look like they are “bulging” or causing eye misalignment, leading to double vision. The swelling can also lead to redness in and around the eyes.

Other symptoms of TED include:

·         Grittiness in the eyes, as if there is sand in them

·         Sensitivity to light

·         Pain behind the eyes

·         Discomfort with eye movement

·         Dryness

·         Extra tearing

·         Puffy or red eyelids

In severe cases, TED can lead to blindness due to significant nerve damage or corneal ulcers.

More severe symptoms include:

·         Inability to close eyelids, which could mean the outer surface of the eyeball is injured

·         Change in how they see colors

·         Losing part of their field of vision, which can happen if the optic nerve is compressed

There are two phases of TED:

·         Active (or inflammatory) – When the disorders of general thyroid disease take place and cause inflammation and other TED conditions to develop; this can last for months or up to a few years.

·         Stable – Inflammation and conditions have stopped manifesting, but the patient is still affected.

Thyroid Eye Disease Treatments

There are many different levels of treatment for TED. An individual’s treatment plan depends on the phase of their TED.

Over-the-Counter (OTC)

OTC treatments are commonly used for mild cases to reduce symptoms and make patients more comfortable during the active phase:

·         Eye drops – Relieve dryness and irritation; make sure to get drops that lubricate and avoid the ones that treat eye redness

·         Selenium supplements – Raise the level of this mineral in the blood to improve immune system activity; selenium deficiency is linked to heightened risk of TED and taking supplements can slow the disease’s progression

·         Aloe vera juice – Reduces inflammation

Prescription Medication

There is a popular medicine exclusively for thyroid eye disease called teprotumumab (Tepezza®). Tepezza was FDA-approved in 2020 and has effectively treated more than 15,000 patients. It targets insulin-like growth factor 1 receptor (IGF-1R) to help prevent muscle and tissue growth behind the eye.

If a patient isn’t given Tepezza, they will likely get prescribed an anti-inflammatory drug, such as prednisone, rituximab or some other corticosteroids.

New medications are on the way that could reduce the number of patients who need surgery.

Surgical Options

Surgery takes place when the patient has reached the stable phase. The procedures are mostly rehabilitative to correct muscle misalignment or damage caused by the swelling. 

Common operations:

·         Eyelid surgery – TED can lead to tight eyelids, which prevent them from closing over the eyes, leading to corneal damage. Eyelid surgery can help repair the eyelidsso they may once again close properly.

·         Eye muscle surgery – This is usually done to correct double vision— known as strabismus; patients may need more than one surgery.

·         Orbital decompression surgery – This is performed to relieve pressure on the optic nerve by making the eye socket larger. This procedure removes small eye socket bones and excess tissue.

Orbital Radiation

This method is another option to decrease inflammation. It is a low-dose radiation therapy to and around the eyes, usually broken up into multiple visits. It is generally for more severe cases of inflammation during the active phase.

Lifestyle Changes

Here are some simple, low-cost therapies and remedies patients can do themselves to reduce their risk of TED or mitigate their symptoms if they’ve been diagnosed:

·         Quit smoking — heavy smokers are eight times more likely to develop TED

·         Place cool compresses on the eyes

·         Wear sunglasses

·         Keep the head higher than the body when lying down

·         Tap or guide eyelids shut when sleeping (for those who have TED that affects their eyelids)

·         Wear glasses with prisms or wearing a patch to reduce double vision

·         Regulate thyroid hormone levels — get guidance from a medical professional and get tested regularly

If you think you have or are at a higher risk for TED or its preceding diagnoses, you should contact a physician or eye care professional.