Thyroid eye disease (TED), also known as Graves’ eye disease or Graves’ ophthalmopathy, is an inflammatory condition in people with thyroid disease. Treatment may include medication, eye drops, and surgery.

People with thyroid eye disease have dry, painful, inflamed eyes. Without treatment, it may cause complications such as bulging eyes and double vision.

Thyroid eye disease is most common in people with Graves’ disease, a type of hyperthyroidism. It can also occur in people with other types of hyperthyroidism. Less commonly, it occurs in people with hypothyroidism, which is an underactive thyroid.

Treatment focuses on managing thyroid disease and then treating the eye symptoms. In most cases, conservative treatment with lubricating eye drops helps with symptoms. However, some people need corticosteroids or other medication. About 2 in 10 people with thyroid eye disease will need surgery.

This article explains which treatments exist for thyroid eye disease. It also discusses the causes of TED and what signs to look out for.

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TED is an inflammatory condition of the eyes that occurs when antibodies that attack the thyroid also attack the eye. Between 25% and 50% of people with Graves’ hyperthyroidism develop this symptom.

Most people get better with a two-pronged approach — treating the underlying thyroid disease and conservative management of eye symptoms. This usually means taking medication to treat the thyroid and using lubricating eye drops to reduce pain and inflammation in the eye.

A relatively new drug, teprotumumab-trbw, may also help. This drug blocks the activity of the insulin-like growth factor 1 receptor. Doctors believe this protein plays a role in the development of TED.


In more severe cases that do not respond well to conservative treatment, a person may need to take a corticosteroid such as prednisone. These drugs weaken the immune reaction that in this case causes the body to attack the eyes and may reduce or even eliminate symptoms.

However, they also cause side effects and can weaken the immune system, so it is important for a person to try other treatments first.

Several different surgeries may reduce pressure and inflammation in the eyes. The most common is orbital decompression. Pressure on the optic nerve is usually the reason why surgery may be necessary.

Orbital decompression removes a portion of the bone between the eye socket and sinuses, creating more space for the eye muscles, so they do not press on other structures. This may reduce bulging and pressure.

In some cases, a doctor may recommend surgery on the eyelid. Strabismus surgery, which can help stabilize the eye muscles, may also help if orbital decompression does not work.

Surgery may also treat some of the appearance changes TED can cause, such as bulging eyes.

Read more about proptosis (bulging eyes) here.

TED may change the way the eyes and face look. This can be scary and may even cause depression or affect relationships. Mental health support from a therapist or a support group can help.

It is also important to develop a plan to manage stress. This is because stress may make TED symptoms worse or reactivate TED when it is in remission.

Read about natural ways to treat stress here.

Hyperthyroidism treatment manages symptoms as well as treating the thyroid itself. Symptom management may include interventions such as eye drops or medication for anxiety and heart palpitations.

To prevent the thyroid gland from producing too much thyroid hormone, a few treatment options are available:

  • radioactive iodine therapy
  • thionamide treatment
  • surgical removal of all or part of the thyroid, also known as a thyroidectomy

Read more about hyperthyroidism here.

Doctors do not fully understand what causes TED, nor why some people with thyroid disease develop it and others do not. Thyroid disease can cause the body’s immune system to attack healthy tissue.

  • Immune cells: Researchers believe that the same immune cells that attack the thyroid to cause thyroid diseases, such as Graves’ disease, also attack body fat and other tissues around the eyes, especially a group of cells known as orbital fibroblasts.
  • Antibodies: Over time, a group of antibodies — anti-thyrotropin receptor antibodies — accumulate in the eye. Their presence causes pain and inflammation. The number of these antibodies correlates with the severity of TED symptoms.
  • Smoking: Research shows that smoking is a significant risk factor for developing TED and for more severe cases of the condition.
  • Hyperthyroidism: 9 in 10 people with TED have hyperthyroidism. 3 in 100 have Hashimoto’s disease, an autoimmune form of hypothyroidism.

Doctors usually diagnose TED based on symptoms. Most people with this condition also have a retraction of their eyelids, so a doctor may look for this sign.

In a person with new eye symptoms, a doctor may recommend bloodwork to test thyroid function. They will also ask about symptoms, examine the eyes, and ask about the history of symptoms.

In some cases, a doctor may recommend imaging scans of the eye, such as a magnetic resonance imaging (MRI) or computed tomography (CT) scan. This enables a doctor to see internal structures and to look for other potential causes of eye pain.

With treatment, the outlook for TED is excellent. Approximately 8 in 10 people with TED need only conservative treatment with eye drops. About 2 in 10 will need surgery. In about 5% of cases, a person may need immunomodulation therapy or steroid treatment.

While the outlook is good, TED can affect mental health and self-image, especially when it changes the appearance of the eyes and face. It may also cause ongoing painful flares. Social and psychological support are important.

A person should contact a doctor for any vision problems or ongoing eye pain. People with a history of thyroid disease should see a doctor for dry eyes, eye pain, or vision changes, even if their thyroid disease is well-managed and in remission.

Treating TED may help prevent complications.

Thyroid eye disease can be very painful. It may make reading, looking at a computer, and other daily tasks unpleasant. It can also affect a person’s vision and, by extension, daily functions such as driving and hobbies.

TED responds well to treatment. Even when conservative treatment fails, several other treatments can reduce symptoms and prevent additional damage to the eye. It is also important to treat the underlying thyroid disease, both to protect the eyes and to prevent thyroid disease complications.

People with eye pain or dryness, as well as those who think they may have thyroid disease, should contact a healthcare professional.