What is Thyroid Eye Disease ?

The thyroid is a gland in the front of your neck. It makes hormones that help control your metabolism.

Thyroid Eye Disease (TED), also known as Graves' Eye Disease is an autoimmune disease. It happens when the immune system is hyperactive. This can damage the thyroid gland as well as other parts of the body, including the eyes. When most people get TED, the thyroid gland makes too much hormone. With TED, the immune system attacks the muscles and tissues surrounding the eyes.

Who Is at Risk for Thyroid Eye Disease (TED) or Graves' Eye Disease ?

You may be more likely to get thyroid eye disease (Graves’ eye disease) if you:

• Have high or low thyroid hormone levels - Abnormal thyroid hormone levels can contribute to TED. These hormones stimulate the same receptors in your eye tissues that the antibodies do.

• Have had radioiodine therapy - RAI therapy is a standard treatment for overactive thyroid (hyperthyroidism), which Graves’ disease causes. But it may contribute to TED or make it worse.

• Smoke - Smoking and secondhand smoke exposure significantly raise your risk of thyroid eye disease. Smoke exposure also makes you more likely to have more severe symptoms that last longer. If you have TED, the best thing you can do for your disease is quit smoking.

• Genetics - Certain genetic predispositions.

What Are Symptoms of Thyroid Eye Disease (TED) or Graves' Eye Disease ?

Symptoms of TED (or Graves' eye disease) can vary and may come and go. Here are some of them :

• Eye protrusion -

TED can cause the muscles in and around the eye to swell and push the eye forward. This eye bulge makes someone look as if they are constantly staring.

• Eyelid retraction -

With the eye pushed forward, the upper and lower eyelids retract (pull back). This makes the white part of the eye more visible.

•Redness of Eye -

Swelling or irritation of the thin coating (conjunctiva) that covers the white part of the eyes may lead to redness of eye, pain while moving the eye and extra tearing of eye.

• Dry eye -

With TED, the eyes are more exposed to wind and dust. This can make the eyes very dry. Dry eye makes the eyes feel scratchy and uncomfortable, and makes vision blurry. Being very sensitive to light is also a problem.

• Vision changes -

Muscle swelling can cause double vision (seeing two images of the same object). Swelling can also pressure and damage the optic nerve (the part of the eye connecting the eye to the brain), which can lead to vision loss.

• Eye “bags” -

When the eyelid swells, it can cause tissue around the eye to bulge. This looks like bags around the eyes, and can make someone look older than they are.

What are the phases of Thyroid Eye Disease (TED) or Graves' Eye Disease?

• Active Phase :

Inflammation causes swelling and worsening symptoms, typically lasting 1-3 years.

• Inactive Phase :

Inflammation stabilizes, but existing damage (like bulging or double vision) may remain.

Treatment & Management of Thyroid Eye Disease (TED) or Graves' Eye Disease:

• Supportive Care : Artificial tears for dryness, sunglasses for light sensitivity, cool compresses, quit smoking.

• Medications : Corticosteroids, immunomodulators for active inflammation.

• Surgery : May be needed for severe cases to address double vision or bulging eyes. TED surgery may be done to reposition the eye or the muscles of the eye, or to remove scar tissue or parts of the eye socket bone. Surgery can :

1. fix eyelid retraction, relieve dry eye and improve the appearance of the eyes

2. help improve vision and bulging eyes

3. help the eye muscles work better

4. push the eye back into a more normal position

5. relieve pressure on the optic nerve to prevent vision loss

• Thyroid Management :

Controlling the underlying thyroid disorder (e.g., hyperthyroidism) is crucial.