What is Thyroid Eye Disease?

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Thyroid eye disease (TED) most commonly occurs as part of Graves’ disease, where the immune system attacks the thyroid, typically causing hyperthyroidism or increased thyroid hormone production.

Thyroid eye disease (TED) most commonly occurs as part of Graves’ disease, where the immune system attacks the thyroid, typically causing hyperthyroidism or increased thyroid hormone production.  In up to 50% of patients with Graves’ disease, inflammation can also affect the tissues around the eyes leading to thyroid eye disease (TED). It’s not clear why the eyes are affected, but immune cells that attack receptors around the eyes cause inflammation and tissue expansion.  Specifically, the insulin like growth factor 1 receptor (IGF-1R) has been identified as playing a central role in the pathogenesis of TED and is the basis for targeted treatment of TED. Women are approximately 5-6 times more likely to experience TED than men.  Smokers have a significantly increased risk for TED.


The disease is recognized to follow two general phases: an active phase where there may be ongoing inflammation and change, and a stable phase during which the inflammation has subsided and there is little day to day changes in appearance or symptoms. Thyroid eye disease can range from mild to severe, and symptoms can be variable from one individual to another.  In the active phase, there is typically inflammation of tissue around the eye as well as tissue expansion. The tissues that typically expand include orbital fat and extraocular muscles. These changes can lead to a variety of clinical findings.

TED Phases

  1. 1

    Symptoms of TED may include:


    • Redness and swelling of the eyes
    • Dry eyes and eye irritation
    • Tearing
    • Eye pain, which may worsen when moving the eye
    • Pressure type pain behind or around the eyes
    • Eyelid retraction (which is the most common sign and is when the upper eyelid is positioned too high)
    • Swelling of the eyelids (often accompanied by redness)
    • Eye bulging or proptosis
    • Bulging of the eyes combined with eyelid retraction creates a staring appearance
    • Double vision
    • Misalignment of the eyes
    • Blurred vision
    • Changes in color vision and/or vision loss (in approximately 5% of patients, most commonly due to compression of the optic nerve due to adjacent eye muscle enlargement)

    Often, symptoms in the active phase may resemble other eye conditions and therefore diagnosis may be delayed. It is important to see a physician who specializes in TED so that you can ensure prompt diagnosis and treatment.

  2. 2

    Thyroid eye disease is a progressive disorder in which damage to various tissues around the eyes can lead to scarring (fibrosis) and tissue remodeling. The extent of scarring and tissue remodeling tends to become apparent during the inactive phase, after inflammation and swelling have subsided. Though the inflammation may have slowed down, the disease unfortunately does not reverse itself. Permanent changes from TED may include eye bulging, eye misalignment, eyelids that appear puffy or swollen due to fat expansion, and even changes in the shape of the face due to expansion of fat pockets. These can lead to chronic issues of eye exposure and dryness, disabling double vision, pain and discomfort, as well as have a significant impact on emotional well-being and quality of life.


Historically, there have been no FDA approved medical treatments for TED. Fortunately, due to groundbreaking clinical research in the field, there is now a targeted treatment for TED that can reverse the disease process that was approved by the FDA in 2020. Additionally, for appropriate patients, customized surgical options are available to improve both function and appearance. Often, surgical rehabilitation can be performed in one surgery, thus minimizing down time and recovery.

Need help with your TED Treatment? Contact us or call us at (310)-433-2052