7 Signs and Symptoms of Thyroid Eye Disease (Graves’ Ophthalmopathy)

Have you been having problems with your vision, in which you experience a range of discomfiting sensations in and around your eyes? Has this coincided with thyroid problems, weight loss, disturbed sleep, and anxiety?

At first glance, it appears that you may be suffering from Graves' ophthalmopathy, also referred to as Thyroid Eye Disease (TED). But if you’re not sure, let’s go through the disease thoroughly so you can get a better idea.

What is Graves' Ophthalmopathy?

Graves' ophthalmopathy, which is alternatively called thyroid-associated orbitopathy is an autoimmune condition that results from an overactive thyroid. Hyperthyroidism can be caused by a number of factors, but the most common is the autoimmune Graves’ disease in which a person’s immune system attacks its own cells. About 30% of people with Graves’ disease also begin to suffer from Thyroid Eye Disease (TED)., but is not necessary that the two should always coincide.

Graves’ disease causes the thyroid gland to come under attack by the body’s immune system which causes an excess of thyroid hormone production, a bulging thyroid gland, excessive sweating and intolerance to heat, palpitations, and irritability, amongst other symptoms.

If the disease does cause Graves’ ophthalmopathy, it is because the cells and connective tissues of the eyes are most vulnerable.

If you have already been diagnosed with Graves’ disease, there is a higher chance of developing thyroid eye disease and so both you and your doctor should keep a close eye on developing symptoms.

Symptoms of TED or Graves’ Ophthalmopathy

Bulging of Eyes

One of the most prominent symptoms of this disease is proptosis when the eyes start to bulge forward and the eyelids retract concomitantly to a greater or lesser extent. The orbital tissues and muscles of the bone cavity in which the eyeball is cushioned expand and become thickset and bulkier. This can cause what is known as the “thyroid stare”, in which the bulging immobility of the eyeballs creates the sense that the person is staring fixedly.

This can cause an inability to close your eyelids fully and in severe cases, the protrusion can endanger the exposed cornea. vision. The retracting eyelids are caused by inflammation and scarring of the tissue. In moderate cases, this symptom will improve over 2-3 years and the eyes will adjust.

Vision Loss and/or Double Vision

But in severe cases, the scarred tissue becomes stiff, compromising vision, causing double vision or progressive and permanent vision loss, damage to the optic nerve, and making eye movement difficult. In very rare situations, once the optic nerve becomes compressed, or the diplopia i.e., double vision begins, vision loss is irreversible. But fortunately, treating the symptoms early can prevent his eventuality.

Puffy and Swollen Eyes

Inflammation will cause puffiness and swelling of the fatty tissue and muscles in the orbital cavity. In mild cases, steroids and corticosteroids like prednisone can be used to mitigate symptoms. However, in cases that have progressed, the swelling will exert pressure on the back of the eye socket which can cause pain while moving your eyes and headaches. Over time, excess swelling may also cause corneal ulceration because the thin epithelium that covers it is exposed. In very rare instances, the swelling of the orbital cavity can result in glaucoma.


Reddening of the white part of the eyes, namely the conjunctiva is the most common presentation of Graves' Ophthalmopathy. Because redness of the eyes is a common feature of many other eye diseases and infections, including conjunctivitis, on its own, it isn't usually a predictor of thyroid eye disease. But if it persists for a longer period, it is better to rule out this possibility.

Dryness and Itching

Because your cornea is exposed due to the retraction of your eyelids, it can reduce the lubrication that the outer covering provides. Your eyes will feel gritty and dry, which in turn causes excess tear production to compensate. This can also cause watery eyes. This is usually treated with artificial tear eye drops, anti-inflammation drops, and eye gels that lubricate. These can be acquired over-the-counter, or by prescription.

Sensitivity to Light

Those with thyroid eye disease may develop photophobia, in which exposure to light can cause extreme pain and sensitivity. This could be to sunlight, LED lights, or fluorescents, and can result in headaches and inability to see properly as well.


The complete loss of vision is a very rare phenomenon if you have Graves' ophthalmopathy. It makes up a very small percentage of people who suffer from this illness.

Risk Factors for TED

A history of Graves’ disease or hyperthyroidism, aging, and cigarette smoking can increase your chances of developing thyroid eye disease.

Treatment, Remedies, and Self-Care

In the initial stages, doctors recommend taking selenium supplements and drinking aloe vera juice, in addition to steroids and autoimmune monoclonal antibody medications like rituximab or teprotumumab.

You can ease the severity of your symptoms at home by following a few self-care tips. These include −

  • Wearing sunglasses while going out to prevent photosensitivity

  • Applying cold compresses on your eyes to reduce heat, pain, and itching

  • Keep your head elevated while sleeping and use tape to shut your eyelids when you sleep (if you are comfortable) so you don’t lose more moisture and damage the cornea more

  • You may also try an eye patch for one eye, so the double vision doesn’t trouble you

Severe cases may require surgery especially if there is no relief from medication or other healing techniques. An ophthalmologist may conduct surgery for orbital decompression in which the eye socket is made larger by taking away the excess fatty tissue, thus reducing the pressure on the optic nerve. You may also have surgery on the eye muscles or the eyelids, the latter of which tries to loosen the tight, stiffness of the eyelids to provide better corneal protection.


Keeping a check on your thyroid levels can save you a lot of trouble in the long run with Graves’ syndrome. The eyes are precious, protect them!

Updated on: 15-Feb-2023


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