Thyroid Eye Disease

See the Expert in Thyroid Eye Disease

Thyroid Eye Disease is a condition that has drastic effects on the eyes, eyelids, and surrounding tissues. Dr. Sherman is an expert in the eye and orbital anatomy, and as an Ophtalmology and Oculoplastic Surgeon, her career has been devoted to treating anything related to the eyes. As an Occuloplastic Surgeon with over 20 years of experience, Dr. Sherman has completed specialized fellowship training to treat patients suffering from Thyroid Eye Disease caused by Graves’ Disease.

What is Thyroid Eye Disease?

Thyroid Eye Disease (TED) is an autoimmune eye condition that’s usually associated with Hyperthyroidism (an over-active thyroid, like in Graves’ Disease). TED occurs when the immune system attacks the thyroid and other tissues around the eyes, leading to swelling and inflammation.

Interestingly enough, the condition can also be seen in people with no other evidence of thyroid dysfunction and occasionally in patients who have Hashimoto’s Disease. Most thyroid patients will not develop Thyroid Eye Disease; those who do develop it might only have mild symptoms. Only a small percentage of Thyroid Eye Disease patients will develop severe vision-threatening symptoms, and most of the severe vision-threatening cases are seen in patients who smoke.

How is it related to Graves’ Disease?

Although TED is not synonymous with thyroid disease, it is often seen in conjunction with Graves’ Disease, a subset of Hyperthyroidism. Graves’ Disease is one of the most common causes of Hyperthyroidism. Oftentimes, TED caused by Graves’ Disease is called Graves’ Eye Disease.

Here are a few different names you might find for the autoimmune eye condition that’s associated with thyroid disease:

• Thyroid Eye Disease (TED)
• Graves’ Opthamolopathy
• Thyroid-associated Orbitopathy (TAO)
• Grave’s Orbitopathy

Before	After

Before	After

Note the improved proptosis or prominence of the eyeballs after orbital decompression surgery and the lid position improvement after eyelid surgery.

Frequently Asked Questions

What are the symptoms and signs of Thyroid Eye Disease and Graves’ Disease?

• Pain in the eyes, specifically pain when looking up, down, or sideways.
• Dryness, itching, dry eyes, difficulty wearing contact lenses.
• Difficulty in completely closing the eyelids, especially while sleeping.
• Puffy, swollen eyelids, inflammation and swelling of the eye and its surrounding tissues.
• Protrusion of one or both eyeballs. Swelling in the orbital tissues causes the eye to be pushed forward or outward — referred to as exophthalmos or proptosis — which can make Thyroid Eye Disease sufferers appear to have a wide-eyed or bulging stare.
• Proptosis is present in 70–90% of cases of Thyroid Eye Disease. The swelling that causes proptosis is due to collections of fluid, fat, and inflammatory cells.
• Bloodshot appearance to eyes. Redness and swelling of the conjunctiva, the thin layer covering the white part of the eye.
• Double vision, called diplopia.
• Impaired or decreased vision, often following reduced brightness of colors.

Is there treatment for Thyroid Eye Disease?

Unfortunately, medical treatment of thyroid disorder or Graves’ disease doesn’t usually eliminate any eye problems, which may last one to three years or longer. Although smokers have higher risks of increased severity of the disease, it’s not possible to predict which patients will develop advanced eye disease. This is why sequential exams are necessary with your eye care provider to monitor your vision. Ocular function assessments are recommended to measure your color and peripheral vision when necessary, and there are options like surgery available to treat physical changes caused by TED.

Before	After
Note the improved position of the upper eyelid after lid retraction surgery.

Mild corneal exposure may be treated with different types of eye drop lubricants (tear supplements) to moisturize the eye. Some patients tape their eyes closed when they sleep to prevent further exposure.

Double vision may be initially corrected with the use of prisms attached to glasses, which partially compensates for limited eye movements. Surgery to treat double vision, which involves repositioning of the eye muscles, is recommended for repair of eye muscle imbalance. This surgery is recommended only after the Thyroid Eye Disease is stabilized and the double vision is measured with sequential measurements.

For patients with loss of peripheral vision and strangulation of the optic nerve, different treatments may be used, including steroid medications, radiation, and/or surgery. Steroid medication decreases the inflammation in the eye muscles and orbital tissue. Steroids are usually given orally, although the intravenous route is sometimes used. The dosage is gradually decreased, and a low dosage is maintained until symptoms improve. Radiation therapy targeted to the tissue behind the eyeball is sometimes used to decrease orbital inflammation. Some physicians use combinations of radiation and steroids.

What are immunosuppressive drugs?

If the inflammation around the eyes is very severe, powerful drugs may be required to tone down the autoimmune process attacking the eyes. Currently, steroids and other immunosuppressive drugs are showing promise in effectively reducing swelling around the eyes and protecting the eyes from deteriorating vision. However, side effects such as weight gain, thinning of the bones and skin, and diabetes, may result if a high dosage is continued for a long period of time. These immunosuppressive drugs are reserved for more severe cases of hyperthyroidism and Graves’ Disease and should be used only under specialist supervision, so the side effects can be monitored.

Is there surgery for Thyroid Eye Disease?

Other cases of corneal exposure may need surgery to reposition the eyelids.

UPPER EYELID RETRACTION surgery allows the upper eyelids to more adequately cover the eyes.

LOWER EYELID RETRACTION surgery helps elevate the position of the lower lid to enhance closure and improve eye dryness.

LATERAL TARSORRHAPHY is a surgery that involves closing the outer corners of the eyelids so that the eyes do not open too wide.

PTOSIS SURGERY fixes upper eyelid droop, and is sometimes needed to raise the upper eyelid so that the patient can see better.

SURGICAL ORBITAL DECOMPRESSION is another important method of relieving severe pressure on the optic nerve, which can threaten vision. The surgery essentially makes room in the eye socket for the swollen and thickened orbital tissue. This allows the bulging eye to relax back into its normal position.

Throughout the course of this disease, multiple visits with an eye physician are an important part of ongoing care for patients with Thyroid Eye Disease.

If you’re suffering from Thyroid Eye Disease caused by hyperthyroidism or Graves’ Disease and you’re seeking corrective surgery, contact Dr. Sherman at the Sherman Aesthetic Center now for a consultation.