Thyroid eye disease (TED) is an autoimmune condition that Graves’ disease frequently causes. There are two stages of TED: active, during which symptoms present, and inactive, when symptoms go away for a time.

TED is an inflammatory condition that affects people with thyroid disease.

Individuals with TED experience dryness, pain, and inflammation of the eyes. Without treatment, TED can lead to complications such as double vision or bulging eyes.

Though it can also occur in people with other types of hyperthyroidism, thyroid eye disease occurs most frequently in people with a type of thyroid condition called Graves’ disease. Because of this, individuals also call TED Graves’ eye disease or Graves’ ophthalmopathy.

TED occurs in stages. This article explains the stages of TED, its causes, and its treatments.

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The active phase of TED describes when symptoms are present and acute.

TED is a rare condition. Its active phase can last anywhere between 6 months and 2 years. Symptoms may occur in one or both eyes or may be more severe in one eye than the other.

Active phase symptoms of TED include:

  • dryness
  • itching
  • grittiness
  • light sensitivity
  • redness
  • double vision
  • misaligned vision
  • puffy eyelids
  • eyelid retraction
  • bulging eyes, known as proptosis

Healthcare professionals may also call the inactive phase of TED the stable phase. During this phase, symptoms tend to disappear and active inflammation reduces.

Although most people do not experience symptoms during the inactive phase, bulging eyes, double vision, and eyelid retraction can still occur.

Healthcare professionals may recommend surgeryduring the inactive phase.

TED is an autoimmune disease. It occurs when autoantibodies activate orbital fibroblasts, which are cells crucial to the development of TED, against thyroid receptors.

In most cases of TED, this phenomenon is due to Graves’ disease.

In fact, around 25–50% of people with Graves’ disease will display TED symptoms.

The treatment approach for TED focuses both on the symptoms and addressing the underlying cause.

Many people will be able to manage the discomfort that TED causes by:

  • using topical lubricants to moisten dry eyes
  • wearing tinted glasses that wrap around the face to reduce pain due to light sensitivity
  • sleeping with eye shields
  • elevating the head of the bed at night

When active inflammation occurs, a person may be able to reduce this inflammation using:

  • steroids
  • anti-inflammatory medicines
  • radiation


When TED leads to eye-bulging or eyelid retraction, a person can improve both the appearance and function of the affected area. They may undergo reconstructive surgery on the eyelid or orbital, which refers to the bones surrounding the eye sockets.

The most suitable type of surgery will depend on the specific kind of eye issues an individual has and their severity. Typically, surgical interventions will progress in three stages:

  • Stage one — orbital decompression: This involves removing part of the bony orbit and fatty tissue behind the eyeball, relieving eye socket pressure. This surgery can help prevent the optic nerve from sustaining damage and permit the eye to resume a more typical position in its socket.
  • Stage two — eye muscle surgery: This procedure aims to correct double vision and any misalignment of the eyes. Surgeons achieve this by repositioning the muscles and controlling the movement of a person’s eye.
  • Stage three — eyelid surgery: Surgical teams perform eyelid surgery to adjust the position of retracted lids, allowing a person to close their eyes more easily and fully. Removing any excess fat from the eyelid area can also provide cosmetic benefits for some people.

While surgery may not eliminate all the signs of TED, it can help in restoring eye and eyelid function, reducing discomfort, and improving aesthetic appearances, if a person has concerns about this.

Read more about treatment for thyroid eye disease.

Smoking increases someone’s risk of developing TED and can potentially worsen symptoms considerably. Treatment for TED also tends to be less effective for those who smoke. Because e-cigarettes also contain nicotine, some believe they may also increase a person’s risk of developing TED.

The following are answers to common questions about thyroid eye disease.

How quickly does thyroid eye disease progress?

Eye issues that TED causes will usually occur and frequently change in type or severity for 6–24 months. The eyes typically do not begin to change again once they have stabilized.

What are the first signs of thyroid eye disease?

Early TED symptoms frequently include excessive eye watering, dryness, and grittiness of the eyes.

TED is an autoimmune condition that causes pain, inflammation, and potential vision issues.

There are two phases of TED. During the active phase, symptoms such as inflammation, pain, grittiness, eyelid retraction, and watering are present. When symptoms go away, healthcare professionals call this the inactive stage.

Typically, healthcare professionals will recommend treatments such as surgical interventions during the inactive stage when a person is not experiencing symptoms.