There are multiple names one can find for the autoimmune eye condition that can be seen with thyroid disease. These include thyroid eye disease, sometimes abbreviated as TED, Graves' ophthalmopathy, thyroid-associated orbitopathy (TAO), and Graves' orbitopathy. This autoimmune eye condition, while separate from thyroid disease, is often seen in conjunction with Graves' disease. The condition can be seen in people with no other evidence of thyroid dysfunction, and is occasionally found in patients who have Hashimoto's disease. Most thyroid patients will not develop thyroid eye disease, and if so, only mildly. Depending on the severity, patients may complain of the following symptoms: 1) pain in the eyes, especially when looking up, down or sideways, 2) itchy, dry eyes, 3) swelling of the eyes and its surrounding tissues, 4) swelling in the orbital tissues which causes the eye to be pushed forward, referred to as exophthalmos, giving thyroid eye disease sufferers a wide-eyed or bulging stare, 5) red eyes, 6) diplopia or double vision, 7) loss of vision.
In mild cases of thyroid eye disease, lubricating drops or ointments are all that is needed to control the symptoms of dry eyes. For pain or swelling, a short course of steroids is usually sufficient. Some doctors recommend orbital radiation, which can be successful in some patients. Patients with thyroid eye disease need to be followed closely for the development of compressive optic neuropathy, which occurs in a small percentage of patients. In this condition, the swelling in the orbit or eye socket can compress the optic nerve, which is responsible for vision, and cause the patient to become permanently blind. For these patients, orbital decompression surgery will be performed to prevent blindness. Orbital decompression can also be performed on patients who have severe proptosis (extruded eyes). Patients who complain of double vision, depending on the severity of symptoms, can either wear prisms on their glasses or have surgical correction to reposition the eye. TED can at times cause the upper eyelids to be drawn up and give a “stared” look. This can be corrected surgically by repositioning the upper eyelids.