Thyroid eye disease (TED) (or Graves' Orbitopathy) is an autoimmune disorder associated with an overactive thyroid due to Graves' disease (a form of hyperthyroidism). It can affect about a quarter of people with Graves' disease. In most cases it is mild. People with TED should be looked after by an eye specialist (ophthalmologist) and a thyroid specialist (endocrinologist).

Content overview

Common symptoms

Risk factors

Treatments for mild cases

Treatments for more severe cases

Other factors

Further information

Common symptoms

• Redness of the lids and eyes
  
• Swelling or feeling of fullness in one or both upper eyelids
• New bags under the eyes
  
• Change in the appearance of the eyes (usually staring or bulging eyes)
•  Pain in or behind the eyes, especially when looking up, down or sideways
  
•  Gritty eyes; or excessive dryness
  
•   Watery eyes
  
•   Intolerance of bright lights
  
•    Blurred or double vision
  
•    Difficulty moving the eyes
  
• TED is sometimes misdiagnosed as conjunctivitis, allergy or hay fever

Risk factors

• If you are a smoker, give it up. If you have Graves' disease smoking increases the risk of getting TED. If you already have TED smoking may aggravate your eye symptoms. Treatment is less effective in people who smoke. These risks rapidly disappear in ex-smokers. Your GP surgery will advise you about help you can get to stop smoking. See also information on the BTF website about Smoking and Graves’ disease.
  
•  Fluctuations in thyroid levels, particularly high Thyroid Stimulating Hormone (TSH) i.e.  hypothyroidism
  
•   Radioiodine treatment can worsen TED if you have active TED

Treatments for mild cases

• Effective lubrication, e.g. artificial tear drops, gels and ointments
  
• Prisms attached to spectacles to help with double vision
  
• Selenium supplements

Treatments for more severe cases

• Steroids to reduce double vision redness and swelling
  
• Steroid treatments combined with other treatments, e.g. immunosuppressive agents and/or radiotherapy for more effective control and to avoid relapse
• Decompression surgery
•  Eye muscle surgery
•  Eyelid surgery

Other factors

•  TED can affect your psychological and social well-being.
  
•  Don’t hesitate to ask your doctor for advice
  
•  If you experience rapid and severe eye deterioration see your doctor without delay and ask for immediate referral to a specialist eye centre with experience of treating TED.

Further information

Read our guide to thyroid eye disease

Read our thyroid eye disease early warning card

Find information about treatments for thyroid eye disease

TED and smoking

TED FAQs

Useful resources (films, patient stories, articles, events, phone support etc.)

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