To rule out Thyroid Eye Disease (TED), doctors use a combination of a thorough eye exam (checking for bulging, redness, limited eye movement, vision changes), specific measurements like exophthalmometry (for protrusion), imaging (MRI/CT scans), and blood tests to check thyroid hormone levels and antibodies, all aimed at identifying inflammation and ruling out other conditions. A key step involves seeing if your symptoms and eye changes improve with thyroid treatment or if other causes for eye issues exist, especially if signs are subtle.
Thyroid Eye Disease (TED) can cause a number of different symptoms. You may notice that some symptoms develop slowly and others appear quickly. In time, TED can leave you with ongoing symptoms like eye bulging, eye pain, double vision, and pressure behind the eyes.
Although autoimmune diseases are lifelong, TED has distinct phases. It may be active for two years or more before the inflammation subsides. During this time, symptoms may come and go and may be mild to severe. TED is mild for most people.
History/Symptoms
The patient complains of gritty sensations, photophobia, lacrimation, dry eye, discomfort, and forward protrusion of the eye. In more advanced cases, patients may have eye socket (orbital) pain, double vision, or blurred vision.
Steroids do not reverse the disfigurement (bulging eyes and retracted eyelids) caused by the disease but they are effective in controlling pain and improving symptoms of double vision that are caused by the inflamed eye muscles in many cases. The treatment consists of one infusion given weekly over 12 weeks.
Thyroid conditions are also more common in women. External examination: Observing the eyes allows the doctor to check for bulging, redness, or swelling. Internal examination: The eye doctor can measure eye pressure to evaluate glaucoma risk, which is associated with thyroid eye disease.
How long will it take to work? This steroid works quickly. You will often notice a change within a few days.
Thyroid Eye Disease (TED) can be confused with a separate condition called Graves' disease. There are a few reasons for this. One reason is that TED and Graves' disease are both autoimmune conditions. Normally, the immune system can tell the difference between your cells and foreign cells, like bacteria.
Often the doctor will order an MRI or CT scan of the brain and orbits. In patients with Thyroid Eye Disease, this test will show which muscles are affected and exclude other conditions. Finally, the doctor will check blood work, especially to see if there are thyroid abnormalities in addition to eye problems.
Although TED can never truly be cured and doesn't fully “go away” in the traditional sense, it can go into remission. For many, the active phase resolves, leaving behind a quieter, more stable condition. Some people experience mild symptoms that linger, while others find their condition stabilizes entirely.
TED is more common in women than men, though men are more likely to have more severe eye disease. The condition can affect people of any age, though it typically occurs in those between ages 30 and 50, and it is less common in children.
Can thyroid eye disease affect only one eye? It may affect only one eye, or one eye more than the other. Thyroid eye disease may begin with either one eye or both or one eye may have more severe symptoms. It is not known why this can occur.
Yes, you can develop or continue to have Thyroid Eye Disease even without a thyroid gland. That's because Thyroid Eye Disease is only partially related to the thyroid. Since TED is an autoimmune condition and not purely a thyroid-related issue, removing the thyroid doesn't stop the immune system's activity.
Eye problems
Early signs of thyroid problems often involve energy, temperature, and body changes, such as unexplained weight changes, fatigue, mood shifts (anxiety/depression), skin/hair issues (dryness, thinning), and altered heart rate or bowel habits, with hypothyroidism causing slow-down (cold, constipation, weight gain) and hyperthyroidism causing speeding up (heat, anxiety, weight loss, fast heart rate).
Symptoms of thyroid eye disease include bulging eyes and seeing double. An eye doctor can prescribe prism glasses to readjust how light enters your eyes, helping you see better.
Yes, an eye doctor can diagnose thyroid eye disease during an eye exam. Your primary care provider, endocrinologist, or eye doctor may diagnose this disease. If your doctor suspects TED based on your symptoms, they will examine your eyes and perform additional testing as needed, such as: A vision test.
Once stabilized, it is unusual for the eyes to start changing again. Some patients are left with permanent changes, and in others the eyes return to normal. A great deal can be done to improve these conditions with medical treatment, although some patients will need surgery to help ease their issues.
Some of the early symptoms of TED are eye pain, redness, dry or gritty eyes, or overly watery eyes, and blurry vision. These symptoms can be mistaken for other conditions, such as allergies. TED is a progressive disease, which means it can get worse over time.
HOW IS TED DIAGNOSED?
In cases where there is more significant inflammation your eyes may need to be treated with steroids which aim to suppress the immune system which is affecting the tissues behind the eyes. These should help reduce redness and swelling of the eyes and the eyelids and can help with double vision,.
This medicine is not for long-term use. Steroid eye drops may cause glaucoma (increased pressure inside the eye) or posterior subcapsular cataracts (a rare type of cataract) if used too long. Slow or delayed healing may also occur while you are using this medicine after cataract surgery.
Key takeaways:
There are many steroid eye drops available. The best one for you depends on the type and severity of your inflammation. Prednisolone acetate (Pred Forte, Pred Mild, Omnipred), dexamethasone (Maxidex), and loteprednol (Lotemax, Alrex, Eysuvis) are three common choices.
Restlessness. In addition to mood changes, prednisone can increase energy levels. Some people may not mind this side effect, but others may feel unpleasantly jittery. It can also make you feel like it's harder to concentrate.