Thyroid Eye Disease Available Through The Generosity Of .

Thyroid Eye DiseaseThis fact sheet has been madeavailable through the generosity of:(Also known as Graves’Ophthalmopathy orGraves’ Eye Disease)What is Thyroid Eye Disease?The thyroid gland canbecome overactive(hyperthyroidism)or underactive(hypothyroidism). Thisis most often due to anautoimmune disease inyour body.For more information, 225 West Wacker DriveSuite 400Chicago, Illinois 60606800.331.2020PreventBlindness.orgThyroid eye disease (TED), sometimes called Graves’ ophthalmopathyor Graves’ Eye Disease, is an autoimmune disease in which the immunesystem causes inflammation and swelling and stimulates the productionof muscle tissue and fat behind the eye. The overactive thyroid gland(hyperthyroidism) is usually caused by Graves’ disease. Up to one-half ofpeople with Graves’ disease develop thyroid eye disease. In some people,thyroid eye disease can occur with normal levels of thyroid hormones(euthyroid) or low levels of thyroid hormones (hypothyroidism). Thyroid eyedisease may occur in patients who already know they have thyroid disease,or it may be the first sign of Graves’ disease. While TED often occurs inpeople living with hyperthyroidism or Graves’ disease, it is a distinct diseaseand treating hyperthyroidism may not resolve the eye symptoms and signs.In the “active phase” of thyroid eye disease, the main symptoms includeinflammation and increased amounts of the tissue, muscles, and fat behindthe eye (in the bony eye socket) causing the eyeballs to bulge out. If theeye is pushed far enough forward, the eyelids may not close properlywhen blinking and sleeping. The front part of the eye, called the cornea,may become unprotected, dry and, damaged. Also, the enlargement of thetissues and muscles of the eyemay prevent it from workingEyelidwell, which affects eye position Eye Musclesand eye movements leadingto double vision. In severecases, the inflammation andCorneaenlargement of the tissues,muscles, and fat behind theeye compresses the opticnerve, the nerve that connectsthe eye to the brain, causingOptic Nervevision loss.This publication is copyrighted. This sheet may be reproduced—unaltered in hard print (photocopied) for educational purposesonly. The Prevent Blindness name, logo, telephone number and copyright information may not be omitted. Electronic reproduction, other reprint, excerption or use is not permitted without written consent. Because of the time-sensitive nature of theinformation contained in this publication, contact Prevent Blindness for updates.MK67 9/20 2020 Prevent Blindness All rights reserved.

Thyroid Eye Disease(continued)Who is at Risk for ThyroidEye Disease?Thyroid eye disease is mostcommonly associated with Graves’disease. It can also occur withnormal thyroid hormone levels orlow levels of thyroid hormones(hypothyroidism).Other risk factors for thyroid eyedisease include: Age: Usually affects middleage adults but can occur atany age Gender: Females are affectedmore than males Family history of thyroideye disease Smoking: Smoking increasesthe risk of thyroid eye diseaseby 7–8 times, causes thyroideye disease to have a longer“active phase”, and it reducesthe effectiveness of treatments Radioiodine therapy:Radioactive iodine has beenused to treat hyperthyroidismand Graves’ disease. Thistreatment should be usedwith caution in people withactive thyroid eye disease asit may worsen the conditionunless steroids are given atthe same time Low blood levels of selenium,a dietary mineral.What are the Symptoms ofThyroid Eye Disease?If you have Graves’ disease, eyesymptoms most often begin withinsix months of disease diagnosis.Very rarely, eye problems maydevelop long after the Graves’disease has been treated. In somepatients with eye symptoms,hyperthyroidism never developsand, rarely, patients may havehypothyroidism. The severity of theeye symptoms is not related to theseverity of the hyperthyroidism.Symptoms of thyroid eye diseaseare caused by the tissues, fat, andmuscles of the eye socket swellingand pushing the eyeball forward.It may be possible that symptomsmay appear in one eye more thanthe other.The symptoms of thyroid eye disease include:Red eyesWatery eyesSensitivityto lightPrevent BlindnessDry, gritty andirritated eyesBulging eyes(called proptosis)and lid retraction –giving a staring orstartled appearancePuffy eyelidsDoublevision2

Thyroid Eye Disease(continued)In more advanced thyroid eyedisease, there may also be: Trouble moving eyes andclosing eyes Visual fields – to assess yourcentral and side vision Inability to completelyclose your eye causinga corneal ulcer Eye movements – to see howmuch your eye muscles havebeen affected Colors appear to be dull ornot as bright Eyelid measurements – tomeasure the eyelid position onthe eye Blurred or loss of vision dueto optic nerve compressionor corneal damageDouble vision can be a symptom ofThyroid Eye Disease. Color vision – to determinehow well you see colorsHow is Thyroid Eye DiseaseDiagnosed?If you have thyroid disease orsuspect that you may havethyroid eye disease, your doctormay recommend that you see aneye doctor. Thyroid eye diseaseis managed by an eye doctor(ophthalmologist). Management ofmore severe forms of the diseasemay require a team of eye doctors,including specialists in eye plasticsurgery, eye muscle surgery, andneuro-ophthalmology. They will beable to evaluate your symptoms,recommend a course of treatment,discuss surgical options to bringyour eyes back to their normalappearance, and help you watch forany problems with decreased vision.To assess your vision and thechanges in the tissues aroundyour eyes, there are several testsyou can expect your eye doctor toperform. The following tests areoften conducted: Visual acuity – to determinehow well you can see far awayand up closePrevent Blindness Eye measurements – tomeasure the amount of eyebulging (protrusion) Eye pressure readings – todetermine the pressure insidethe eye Optic nerve visualization –to look into the back of youreye to see if the optic nerveis affected Magnetic resonance imaging(MRI) scan or computedtomography (CT) scan – tosee how much enlargementthere is in the tissue andmuscles behind the eyeHow is Thyroid Eye DiseaseTreated/Managed?Thyroid eye disease in its activephase can last between one andthree years. That means if it isleft untreated, the inflammationmay gradually decrease by itselfbut may cause damage to visionthrough the course of the disease.Sometimes, the changes causedby the enlargement of the tissues(such as bulging eyes or doublevision) may not go away. The goalof treatment is to limit inflammation3

Thyroid Eye Disease(continued)and swelling occurring during theactive or inflammatory phase andto protect the front of the eye andprevent vision loss.Thyroid eye disease is managedby a specialist eye doctor(ophthalmologist). Any underlyingthyroid problems will be managed byyour primary care doctor (PCP) or bya specialist in the hormone systemsof the body (an endocrinologist).If a thyroid issue is suspected,evaluation and treatment are critical.The first priority is to restore yournormal thyroid function. In addition,eye conditions should be examinedand treated at the same time asyour thyroid gland treatment. Eyeproblems may continue to progresseven after your thyroid functionreturns to normal.What Can I Do to Help My Vision?If you have thyroid eye disease, youreye doctor may recommend one ormore of the following treatments tohelp soothe your eyes and improveyour vision: Cool compresses: Apply coolcompresses to your eyes. Theextra moisture and coolingeffect may provide relief. Sunglasses: When you havethyroid eye disease, youreyes are more sensitive tosunlight and UV rays. Wearingsunglasses helps protect themfrom both sun and wind. Lubricating eye drops: Uselubricating eye drops, likeartificial tears. It mayhelp relieve dryness andPrevent Blindnessscratchiness. Make sure to useeye drops that do not containredness removers. Lubricatinggels can be used before bedto prevent the cornea (thefront of the eye) from dryingout because your eyelidsmay not close completelywhen sleeping.Note: If you have difficultyclosing your eyelids, you maybe at risk to develop a cornealulcer. The cornea is a clearlayer that covers the front ofthe eye. A corneal ulcer isan open sore on your corneaand it can cause scarring andpermanent loss of the vision.A corneal ulcer causes rednessof the eye, pain and usually adecrease in vision. You shouldseek immediate attentionfrom your eye doctor for theseproblems. Taping: Talk with your doctorabout taping your eyelidstogether to help protect yourfront of your eye (cornea) fromdrying when your eyelids donot close completely duringsleep. Elevate your head whenlaying down: Keeping yourhead higher than the rest ofyour body may reduce swellingand may help relieve pressureon your eyes. Quit smoking: Smoking (andsecond hand exposure tosmoke) is an important riskfactor for thyroid eye disease.If you smoke, quit, and avoidsecond hand smoke.4

Thyroid Eye Disease(continued) Steroids: Swelling in your eyesmay be improved by treatmentwith steroids (such ashydrocortisone or prednisone).Your doctor may recommendeither intravenous or oralmedication. Note, make sureyou discuss the risks of useof steroids with your doctorbefore use. Selenium supplements:Recent studies suggests thatpatients with mild active thyroideye disease may benefit fromselenium supplements. Talkto your doctor before startingsupplements. Prisms: Thyroid eye diseasecan cause scar tissue todevelop in your eye muscles.This can lead them to becomeshort and pull your eyes outof alignment, causing doublevision. If double vision occurs,glasses containing prismsmay be prescribed by yourdoctor. However, prisms donot work for all people withdouble vision and your doctormay recommend patchingone eye for temporary relief oreye muscle surgery as a moreeffective option when changeshave stabilized. Eyelid surgery: When youhave thyroid eye disease,the eyelids are usually morewidely open with a “startledlook” because the muscles inthe eyelids may tighten andpull the upper lid up and thelower lid down. You may havedifficulty closing your eyelids,Prevent Blindnessleaving the front of the eye(cornea) more exposed, whichcauses tearing, irritation andsusceptible to developing acorneal ulcer. Eyelid surgerymay help reduce exposure ofthe cornea. Eye muscle surgery: Eyemuscle surgery may helpcorrect your double vision bymoving the affected musclefarther back from its originalposition on the eyeball. Thissurgery will help to correct yourdouble vision when readingand looking straight ahead.Sometimes, you may needmore than one surgery to geteffective results. Orbital decompressionsurgery: Thyroid eyedisease can cause swollentissues around the eye thatcompresses the optic nerve.The optic nerve provides theconnection between youreye and the brain. When thenerve is compressed, colorvision becomes abnormal,lights may seem dimmer thanusual, and the sharpness ofthe vision decreases. Orbitaldecompression surgery can bedone to improve your vision.The surgery makes the eyesocket bigger or removes someof the excess tissue. Whenthe nerve is compressed, thegoal of surgery is to get theeye and the inflamed tissuemore space and decreasespressure on the optic nerve.Even when the optic nerve5