Unless you have Graves’ disease, you may not be familiar with thyroid eye disease. These two conditions often occur simultaneously, affecting the same people.
Graves’ disease is a condition in which a person’s immune system attacks certain cells and tissues in the body, including the thyroid gland, the same way it would attack foreign bacteria or viruses. In people with Graves’ disease, this leads to an overactive (i.e., “hyper”) thyroid, according to the American Thyroid Association.
In many people with Graves’ disease, the body attacks both the cells of the thyroid gland and the cells located behind the eyes. This results in thyroid eye disease, says Andrea Kossler, MD, FACS, an assistant professor of ophthalmology at the Stanford University Medical Center in Palo Alto, California, and a specialist on thyroid eye disease.
Because the symptoms of thyroid eye disease can be nonspecific or attributed to more common conditions, it may go undiagnosed at first, especially if you haven’t been diagnosed with Graves’ disease. (If you have been diagnosed with Graves’ disease, an ophthalmologist should be monitoring your eyes for changes.)
It’s important to be treated for both Graves’ disease and thyroid eye disease right away to help keep the conditions from worsening, says Dr. Kossler. Some good news, she says, is that “[Most] of the time, a patient’s disease will be limited to mild symptoms.”
But Kossler estimates that about 1 in 4 people will develop moderate or severe thyroid disease, with symptoms ranging from vision problems to changes in the eye’s appearance.
Here are seven symptoms of thyroid eye disease to watch out for. If you’ve been experiencing any of them, talk to your primary care provider or ophthalmologist.
1. Redness
Redness that appears in the white part of the eye (the conjunctiva) is a common symptom of mild thyroid eye disease, says Madina Falcone, MD, the director of oculoplastics and orbital surgery at UConn Health in Farmington, Connecticut. An autoimmune disease triggers inflammation, which ultimately results in redness, she explains. Many conditions can cause redness, though, including eye infections, which is one reason thyroid eye disease can be overlooked.
“Patients are commonly told that they have an allergy or this is just a symptom of aging,” says Dr. Falcone. “This can be very frustrating for patients to hear.”
2. Dry Eye (Grittiness) or Excessive Tearing
Inflammation can also lead to a range of eye issues, including dry eye, which can feel as if they’re constantly gritty. Artificial tears can help restore lubrication, says Kossler. Paradoxically, dryness can also cause watery eyes, because the body ramps up tear production to combat the irritation, according to the Mayo Clinic.
3. Swelling/Puffiness
Another result of inflammation can be swelling or puffiness, which can be helped with steroids. But if the disease has progressed, more severe symptoms (mentioned below) can’t be helped by steroids.
4. Proptosis (Bulging Eyes)
Proptosis, or bulging eyes, occurs when inflammatory cells in the orbit (the bony cavity where the eyeball sits in your skull ) become activated, stimulating orbital tissue to expand, says Falcone.
“The muscles that surround and move the eye enlarge, and the fat that surrounds and cushions the eye also thickens,” she says. As the entire area gets bigger and bulkier, the eyeballs will begin to bulge forward.
“In the past, we used to treat people with steroids to address redness and swelling, but it didn’t have a great effect on the position of the eye,” she says.
5. The ‘Thyroid Stare’
When a person’s eyeballs bulge forward, their eyelids become pushed back, and muscles that open and close the eyelids can also become more restricted. “This leads to the ‘thyroid stare,’ where patients look like they’re staring,” says Falcone. If this happens, people may have difficulty closing their eyes.
6. Double Vision (Diplopia)
In severe thyroid eye disease, double vision is always present, says Falcone. That’s because as the eye bulges forward, the muscles that surround the eye aren’t able to move properly, says Kossler.
“With thyroid eye disease, people might have flares, or worsening of the redness, swelling, and grittiness, that go away,” says Falcone. “However, usually once they start to notice symptoms like bulging and decreased vision, these symptoms don’t resolve without treatment.”
7. Vision Loss
The most severe form of thyroid eye disease can cause vision loss. This occurs when the optic nerve, which tethers the eyeball to the brain, becomes compressed, says Kossler.
