Thyroid eye disease (also known as Graves’ orbitopathy) is an autoimmune condition often associated with an overactive thyroid gland (Graves’ disease).The disease can cause your eye muscles, eyelids, tear glands and fatty tissues behind your eyes to become inflamed. This inflammation pushes your eyes forwards and causes them to become red, swollen and bulge outwards.This can lead to the eyes being out of line with each other, resulting in double vision and even a loss of sight if there is too much pressure on your optic nerve (at the back of your eyes) or cornea (at the front of your eyes).
Thyroid eye disease - eye centre
Also known as: Graves’ orbitopathy, Ophthalmopathy
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What causes thyroid eye disease?
Thyroid eye disease (Graves’ orbitopathy) is caused by an autoimmune condition. When functioning correctly, your immune system produces antibodies to protect you from germs and bacteria that can make you ill.
However, when you have an autoimmune condition, your immune system may mistake your eye muscles and the fatty tissues around your eye for a foreign invader. As a result, your immune system may produce antibodies to attack these tissues, causing them to expand.
In many patients, thyroid eye disease is related to an autoimmune condition that affects the thyroid gland, such as Graves’ disease, which causes either an overactive or underactive thyroid (hyper or hypothyroidism). Thyroid eye disease is normally associated with hyperthyroidism, though it can even occur in the absence of Graves’ disease or hyperthyroidism.
Thyroid eye disease diagnosis
An ophthalmologist will be able to diagnose thyroid eye disease by doing a comprehensive eye exam to assess the surface of your eyes and any swelling in or around your eyes.
To get a thorough view of your entire eye, they may also use certain types of imaging techniques, such as:
- ultrasound – this method uses high-frequency sound waves to take pictures of the structures around your eyes
- computed tomography (CT) – a CT scanner takes X-ray pictures of your eyes from many different angles to create very detailed images
- magnetic resonance imaging (MRI) – an MRI machine uses magnets and radio waves to take pictures of your eyes
If after the above imaging tests your ophthalmologist suspects that you have thyroid eye disease, they may also order some blood tests. These can help them to check whether the levels of your thyroid hormones and antibodies are too high or too low, enabling them to potentially get to the bottom of the underlying cause of your thyroid eye disease.
You may also be referred for additional testing if your ophthalmologist believes that your thyroid eye disease has resulted in complications, such as strabismus (misaligned eyes) or glaucoma (increased pressure within the eye which can damage your optic nerve).
Wondering if you might have thyroid eye disease? Book an appointment with one of the specialists at The London Clinic Eye Centre today.
* We offer fast appointments Monday – Friday only.
Thyroid eye disease treatments
At The London Clinic Eye Centre, we understand the impact thyroid eye disease can have on your quality of life, and our expert team of consultants is dedicated to diagnosing and addressing the underlying causes of your concern to provide effective treatment options.
The treatment options for thyroid eye disease include:
Thyroid eye disease can affect the eyes in many ways. The expert consultants at The London Clinic Eye Centre can help manage common symptoms of dry eyes, and can supervise treatment with anti-inflammatory drugs to try to stop the inflammation of the eye muscles and to prevent vision loss if the optic nerve is at risk of being compressed, and can help with eyelid surgery or squint surgery when these are needed.
If your symptoms of watery eyes are mild and not caused by a blocked tear duct or other more serious issue, you may be able to treat your condition at home.Home remedies for epiphora include:
- Using eye drops to lubricate the eyes
- Taking regular breaks from reading, watching TV, or using the computer
- Holding a warm, damp cloth over the affected eye
- Massaging the eyelid to release any blockages
- Using a wipe to remove any dirt or debris from the eyes and eyelids
- Using over-the-counter medication to relieve allergy symptoms
- Avoiding irritants to see if your watery eyes get better without further intervention
However, if the issue persists, you should get in touch with The London Clinic Eye Centre to get booked in with an eye specialist who can diagnose what the underlying cause may be.
Certain changes in your lifestyle may help to relieve some of the symptoms of thyroid eye disease. In particular:
- Quitting smoking (as smoking can exacerbate thyroid eye disease)
- Wearing sunglasses
- Taking selenium supplements
- Keeping your head higher than your body when you lie down
- Wearing prism glasses to help treat double vision that may be caused by thyroid eye disease
- Using a patch on one eye to help treat double vision by forcing your weaker eye to work properly
- Using cooling eye masks when you sleep
- Managing your stress, as stress can make the symptoms of thyroid eye disease worse
Your doctor may prescribe:
- eye drops – to reduce dryness and irritation
- prednisone, steroids or rituximab – these are all anti-inflammatory drugs which work to suppress autoimmune conditions
- teprotumumab – a new medicine designed specifically to treat thyroid eye disease
- Eyelid surgery (blepharoplasty) – if your eyes have swollen to the point that you can’t close them properly, you’re at risk of corneal damage. Eyelid surgery can help to correct this issue so that you can keep your cornea (the front surface of your eye) covered
- Eye muscle surgery – if you have strabismus or double vision, you may need surgery to help reposition the muscles around your eye to correct your vision
- Orbital decompression surgery – if your thyroid eye disease is causing glaucoma, this surgery can relieve the pressure on your optic nerve by making your eye socket larger or by taking away excess tissue
Eye surgeries on the eyelids to treat watery eyes are typically performed in the operating theatre under local anaesthetic as a day patient.However, the dacryocystorhinostomy for a blocked tear duct is usually done under a general anaesthetic and your consultant will discuss with you whether they feel you can go home on the same day or require you to stay in hospital overnight. You will usually be advised to take a couple of weeks off work.You may be given medication to take home and will be advised not to rub your eyes or blow your nose for the first two weeks after the operation.
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