With thyroid eye disease, your immune system attacks parts of your eyes. Your eyelids, eye muscles, eyeballs, tear glands, and other tissue can get inflamed and swollen. Your symptoms may stay stable for a while or get better or worse over time.
Most symptoms are mild, but others are more serious. It’s rare, but some problems can cause vision loss if you don’t get care quickly.
Just because you have one symptom of thyroid eye disease doesn’t mean you’ll have all of them. But here are some signs to watch for.
Eye Swelling and Redness
Thyroid eye disease causes lots of inflammation, including in the soft tissue in and around your eyes and eyelids. You might get pain and pressure along with:
- Redness or bloodshot eyes
- Swelling in the white parts of your eye
- Puffy tissue around your eyes
Your doctor might suggest at-home remedies or give you medicine to ease swelling and other symptoms.
Inflammation can affect the muscles that support your eyelids. They can get swollen, tight, or scarred. That’ll shorten the muscles and pull your eyelids back to expose more of the whites of your eyes. You might look like you have a surprised expression on your face. You might also have a delay in how your upper eyelid moves when you try to watch a moving object.
Your eyelids could get better on their own. But get help right away if you can’t close your eyes all the way.
Surgery may be an option to lengthen your eyelids so it’s easier to close them. Your doctor will decide if that’s right for you.
Swollen muscle or fat can push your eyes forward. At first, it’s inflammation that causes the bulging. But you can develop scarring over time that sticks around even after the swelling goes down. The scarring can continue to push the eyes forward.
The bulging of your eyes, called exophthalmos or proptosis, may get a little better over time. But your eyes may never go totally back to normal. If that’s the case, your doctor might suggest surgery. Your condition will probably need to be stable for about 6 months before you can have the procedure.
Double Vision or Misaligned Eyes
All that swelling can make it hard for your eye muscles to move together. If your eyes are out of sync, you can get double vision, blurry vision, or misaligned eyes. That means that your eyes may not look in the same direction or focus on an object at the same time.
Special lenses called prisms can help with double vision. An eye patch may help, too. But sometimes people need surgery.
Dry, Gritty, or Teary Eyes
The film over your eyes can dry out. It might feel like you’ve got something in your eye. Irritation can make your eyes tear up a lot, too. That means it’s possible for your eyes to be both dry and watery.
This dryness can happen for several reasons, such as:
- Bulging eyes are more exposed to the air.
- Eyelid retraction can make it hard to blink or close your eyes all the way.
- Inflammation can cause certain glands to make fewer tears.
- The hydrating film over your eye may not soak up the tears you do make.
Severe dry eyes can lead to an ulcer on the cornea, the clear surface of the eye. If left untreated, you could lose your eyesight.
Special lubricating drops, gels, or ointments can help your eyes stay moist. Your doctor can recommend the right product and tell you how often you should use it.
Sensitivity to Light
People with eye inflammation often can’t handle bright lights. Your eyes may also be more sensitive to dangerous ultraviolet light from the sun. You can protect your eyes with sunglasses.
When Is It an Emergency?
Most people don’t have serious problems from thyroid eye disease. But some symptoms can threaten your eyesight. It’s rare, but you could get optic neuropathy. That’s when the muscles around your eye put pressure on your optic nerve -- the nerve that goes from your eye to your brain.
Get medical help right away if you have:
- Serious eye pain
- Sudden or patchy vision loss
- Problems with peripheral vision
- Nausea or throwing up
- Problems seeing bright colors
Your doctor can reduce the pressure on your optic nerve to save your vision.
Photo Credit (Header): PeopleImages / Getty Images
Photo Credit (Inset): Clinical Photography, Central Manchester University Hospitals NHS Foundation Trust, UK / Science Source
National Organization for Rare Disorders (NORD): “Thyroid Eye Disease.”
American Thyroid Association: “Graves’ Eye Disease.”
Saudi Journal of Ophthalmology: “Review of the treatment of Graves’ ophthalmopathy: The role of the new radiations techniques.”
Turkish Journal of Ophthalmology: “Thyroid-associated Ophthalmopathy.”
Fox, T.J. and Anastasopoulou, C. Graves Orbitopathy, StatPearls, 2020.
UW Health: “20 Questions About Thyroid Eye Disease.”
Clinical Ophthalmology: “An assessment of the ocular tear film in patients with thyroid disorders.”
Community Eye Health Journal: “Emergency management: optic nerve compression.”