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Thyroid Eye Disease Treatment

Medically Reviewed by Whitney Seltman, OD on November 17, 2020

Treatment of thyroid eye disease can ease your symptoms and help correct any eye damage you may have from the condition. The type of treatment your doctor uses depends on which stage or phase of the condition you’re in.

Phase-Based Treatment

The active phase is when your symptoms are at their peak. You probably have itchy, dry, puffy, irritated eyes. You may have trouble closing your eyelids. You could even have problems with your vision. This phase can last from several months to up to 2 years.

The goal of treatment during the active phase is to relieve the symptoms. Your doctor will aim to preserve your sight and protect the surface of your eye (called the cornea) from damage. They can also work on correcting any double vision you might have from the disease or as a side effect of surgery.

The inactive phase is when your disease has settled down and stabilized. Most symptoms are not active at this time, but your eyes may still bulge and have some problems.

Once you enter the inactive or stable phase, your doctor can perform any surgery you might need to correct damage such as double vision or eyelid retraction.

Treatment Options

If your symptoms are mild, you may be able to manage them on your own with aids such as:

  • Over-the-counter eye drops (artificial tears)
  • Lubricating gels
  • Cool compresses
  • Keeping your head elevated during sleep
  • Selenium supplements

Double vision is a side effect that can happen early on, or later after surgery. Your doctor may suggest prisms, a type of lens, in your glasses to help correct it. Prisms don’t work for everyone, but they can help people ease eye strain and train eye muscles back to single vision.

More severe symptoms might need medication, radiation, or surgery.

Medications

Corticosteroids: These medications, such as prednisone, can ease the swelling in your eyes. They may also help with double vision. Corticosteroids dampen your immune system, so you don’t have as much inflammation in your body. You can take them by mouth, or your doctor can inject them into your eye.  You can only take them for a few weeks. If you take them for longer than that, you’re likely to have more side effects, which include:

  • Fluid retention
  • Weight gain
  • High blood sugar levels
  • High blood pressure
  • Mood swings

Teprotumumab (Tepezza): This is a new medication that reduces eye bulging and inflammation. You get this medication through an IV in your arm every 3 weeks. You take it for eight rounds. It can cause side effects such as nausea, diarrhea, muscle spasms, and higher blood sugar levels.

Radiation

Orbital radiotherapy: Doctors aren’t clear how well this treatment works. They may try it if your symptoms are getting worse and corticosteroids aren’t a good option for you. Your doctor uses X-rays focused on the tissue just behind your eye. This destroys the tissue. There are risks involved, such as damage to your retina. Be sure to talk to your doctor about if the benefits outweigh those drawbacks.

Surgery

Orbital decompression surgery: If you’re in danger of losing your eyesight because of pressure on your optic nerve, your doctor may suggest this surgery. During the procedure, your doctor removes the bone between your eye socket (orbit) and your sinuses (air spaces beside your eye socket). The swollen tissues can fill this area. This gives your eyes more space to shift back to their normal position. The surgery could cause double vision.

Eyelid surgery: Bulging eyes caused by thyroid eye disease can sometimes keep you from closing your eyelids all the way, leading to dry and irritated eyes or cornea damage. A surgeon can help correct the problem by cutting and repositioning your eyelids to help them close fully.

Eye muscle surgery: If scar tissue on one or more of your eye muscles makes them shorter than they should be, you may need surgery to realign them. This also corrects double vision caused by scar tissue. A surgeon cuts the scarred muscle from your eye and reattaches it farther back. It may take more than one surgery before your double vision gets better.

WebMD Medical Reference

Sources

SOURCES:

NHS: “Exophthalmos (bulging eyes).”

Michigan Medicine Kellogg Eye Center: “Thyroid Eye Disease (TED or Graves Eye Disease),” “Thyroid Eye Disease - What to Expect.”

Mayo Clinic: “Graves’ disease.”

Harvard Health: “Graves' Eye Disease (Graves' Ophthalmopathy).”

American Thyroid Association: “Graves’ Eye Disease.”

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