Thyroid Eye Disease (TED), also called Graves' orbitopathy or thyroid-associated ophthalmopathy, is a serious condition where the immune system mistakenly attacks the tissues around the eyes. This leads to inflammation and a range of symptoms, which can vary from mild discomfort to severe complications, including changes in the appearance of the eyes or even vision impairment.

Common Signs and Symptoms of Thyroid Eye Disease (TED)

The symptoms of TED can range from mild irritation to more serious changes that affect vision. Below are some common signs to look out for:

Protruding Eyes (Exophthalmos): A hallmark symptom of TED, exophthalmos occurs when the eyes bulge outward due to inflammation and swelling of the tissues around the eye socket. This condition usually develops gradually and may go unnoticed at first.

Dryness and Irritation: Many individuals with TED experience dryness, redness, and discomfort, similar to dry eye symptoms. However, common over-the-counter treatments provide only limited relief in these cases.

Eyelid Swelling or Retraction: Swelling or retraction of the eyelids is a frequent symptom in TED, which can make the eyes appear "stiff." This may be confused with allergies or conjunctivitis.

Double Vision (Diplopia): Swelling of the muscles behind the eyes can lead to double vision, particularly when looking in specific directions. If untreated, this double vision can worsen over time.

Eye Pressure or Pain: Many people with TED report a constant feeling of pressure, discomfort, or even pain around the eyes, especially with eye movement or straining.

Sensitivity to Light (Photophobia): Inflammation in the eyes can cause increased sensitivity to light, a symptom that is often mistaken for migraines or other conditions.

Difficulty Moving the Eyes: In TED, swollen and stiff eye muscles can make it hard to move the eyes in certain directions without discomfort or double vision. This can result in a reduced range of motion or restrictive myopathy.

The intensity of these symptoms can vary, and some may develop gradually or subtly, causing TED to progress differently in each individual. If these symptoms persist, it’s important to consult with an ophthalmologist for a thorough examination.

TED May Be More Common Than You Think

Although TED may seem like a rare disease, it’s actually quite common among people with thyroid disease. Research indicates that about 50% of people with thyroid disease, particularly in white populations, also have TED. For the general U.S. population, the incidence is around 16 cases per 100,000 women and 2.9 cases per 100,000 men (Source: National Library of Medicine).

TED typically has a bimodal peak in incidence, with women experiencing peaks between ages 40-44 and 60-64, and men peaking at ages 45-49 and 65-69. Older individuals are at higher risk of developing more severe forms of TED, including restrictive myopathy and dysthyroid optic neuropathy (DON) (Source: National Library of Medicine).

Environmental Factors: Smoking is strongly associated with TED, as it can exacerbate symptoms and increase the risk of developing the condition. Managing environmental factors, such as quitting smoking, can help reduce the risk of TED and improve outcomes.

Treatment Options for TED

Treatment for TED varies depending on the severity of symptoms. One of the most effective treatments is Tepezza (teprotumumab), a drug specifically designed for TED. Tepezza works by targeting proteins that cause inflammation and tissue swelling around the eyes, significantly improving symptoms like bulging eyes and double vision, as well as enhancing both appearance and vision (Source: Tepezza).

In mild cases, lubricating eye drops or wearing sunglasses can help relieve dryness and light sensitivity. For severe cases, surgical procedures like orbital decompression may be required to preserve vision (Source: Thyroid Eyes).

Final Thoughts

Recognizing the symptoms of TED early on allows for timely intervention, potentially stopping the disease’s progression. Greater awareness of TED’s prevalence and associated risk factors has made it easier for people to seek specialized treatment. If you or someone you know is experiencing persistent eye symptoms or has a history of thyroid disease, it’s essential to consult an ophthalmologist for further evaluation.