From 9 to 15 November we mark Thyroid Eye Disease Awareness Week – a chance to remind ourselves that the thyroid affects not only metabolism, mood and weight, but also the eyes. Many patients with Graves’ disease attribute symptoms such as stinging, redness or swollen eyelids to tiredness or allergies for a long time. Recognising the symptoms in time, however, allows the disease to be monitored and treated at the stage when protecting vision is most effective.
What is thyroid eye disease?
Thyroid eye disease (also known as Graves’ orbitopathy or endocrine ophthalmopathy) is an autoimmune disease: the immune system mistakenly attacks the muscles and fatty tissue in the eye socket, which then swell. It most often occurs with an overactive thyroid in Graves’ disease, but it can also appear with an underactive or entirely normal thyroid, according to the American Academy of Ophthalmology (AAO). According to the organisation Prevent Blindness, eye changes develop in up to half of people with Graves’ disease, and women are affected more often.
The disease usually goes through two phases. In the active (inflammatory) phase, which can last from one to three years, the tissues are swollen and the symptoms change. This is followed by the stable phase in which the inflammation subsides, but some changes, such as bulging eyes, may remain.
Symptoms not to ignore
Symptoms can be mild and changeable, and sometimes one eye is affected more than the other. The most common are:
- dryness, a gritty feeling and stinging, often with increased watering and sensitivity to light
- redness of the whites of the eyes and swollen eyelids, especially in the morning
- bulging eyes (exophthalmos) and retracted eyelids, which make the gaze look “startled” or fixed
- double vision, especially when looking up or to the side, and pain or pressure behind the eyes when moving them
- less often, blurred vision or faded colours – a sign that the swelling may be pressing on the optic nerve
Who is at higher risk?
The disease can appear at any age, but it is more common in people with Graves’ disease or a family tendency to autoimmune thyroid disease. The most important factor we can influence is smoking: according to Prevent Blindness, smokers have a seven to eight times higher risk, their active phase lasts longer and treatment is less effective. It is also important for thyroid hormones to be balanced, so good cooperation with an endocrinologist is part of protecting your eyes.
How is it diagnosed?
During the eye examination we check visual acuity, colour vision, eye movements and eyelid position, the surface of the eye and eye pressure. The degree of protrusion is measured by exophthalmometry – a simple, painless measurement that shows how far the eye has moved forward. Repeated measurements over time show whether the disease is stable or progressing. Imaging of the optic nerve and retina with optical coherence tomography (OCT), which is part of our Premium Plus eye examination, helps monitor the condition of the optic nerve. If needed, the doctor may also recommend imaging of the eye sockets and laboratory tests in consultation with an endocrinologist.
What can help you in everyday life
Treatment depends on the activity and severity of the disease. In milder forms, measures to protect the surface of the eye and control of risk factors are often enough, while in moderate and severe forms anti-inflammatory medicines are used, and in the stable phase, if needed, surgery on the eyelids, muscles or eye socket, according to the European EUGOGO guidelines. Alongside the treatment prescribed by your doctor, these habits can also help:
- If you smoke, quitting is one of the most important steps for the health of your eyes.
- Use preservative-free artificial tears during the day, and a gel or ointment before sleep if your eyelids don’t close the eye completely.
- Wear sunglasses with UV protection – they protect against light, wind and drying out.
- Sleep with your head slightly raised; morning eyelid swelling is then often smaller.
- Cold compresses can ease the feeling of swelling and discomfort.
- Have your thyroid hormones checked regularly and don’t skip scheduled examinations.
When to see an ophthalmologist?
If you have thyroid disease, it is advisable to have an eye examination as soon as you notice any change in your eyes or eyelids, even if it seems mild. Don’t delay the examination if you notice:
- bulging of one or both eyes or a change in the look of your gaze,
- double vision or pain when moving your eyes,
- dryness and redness that don’t go away with artificial tears.
Contact us urgently if your vision becomes blurred or weaker, if colours look paler than before or if you cannot close your eyes – these are signs that require prompt assessment.
Conclusion
Thyroid eye disease can seem frightening, but with early recognition, regular monitoring and cooperation between ophthalmologist and endocrinologist, most patients get through the active phase successfully and keep good vision. At Poliklinika Pavan the examination includes measuring eye protrusion, assessing the surface of the eye and, if needed, imaging of the optic nerve. See our services, and you can book an appointment at 047 655 999 or via contact form.
Sources: AAO – What Is Thyroid Eye Disease (TED)?; Prevent Blindness – Thyroid Eye Disease; Bartalena L. i sur. The 2021 EUGOGO clinical practice guidelines for the medical management of Graves’ orbitopathy. Eur J Endocrinol. 2021; Prevent Blindness – Thyroid Eye Disease Week 2026.
