Thyroid Eye Disease Progression and Prognosis

Learning you have an autoimmune condition such as thyroid eye disease (TED) can be disconcerting. This condition commonly occurs in those with a hyperactive thyroid, but it can also affect those with a hypoactive thyroid and some with no prior thyroid issues. The hallmark of this eye disorder is the distinctive way the eyes may bulge.

Thyroid eye disease can be caused by Graves’ disease, an autoimmune condition in which the body views its own thyroid as foreign and attacks it with antibodies. The result may be an overactive thyroid.

When antibodies attack the eye muscles, thyroid eye disease may develop. The symptoms can include swelling of the surrounding fat and muscles, causing the eyes to protrude.

Risk Factors

Thyroid eye disease affects about 1 million Americans. Women in particular are at risk, developing this condition at a rate of five to six times that of men. Anyone who is a cigarette smoker is at significantly increased risk of not only developing thyroid eye disease, but also contending with a more severe vision-threatening form.

Disease Progression

Those with thyroid eye disease can be in one of two phases. During the initial active phase of this condition, inflammation occurs, and efforts are concentrated on relieving eye symptoms.

Such symptoms can include:

• Dry eyes
• Double vision
• Eye protrusion
• Eyelid retraction
• Vision loss

This active phase of thyroid eye disease may typically last from six months up to two years. During this time, symptoms may continue to change. Treatments such as surgical options are put on hold until healthcare providers feel certain they can get solid results.

However, in this early stage, medication to tamp down on swelling and inflammation associated with the condition may have its best results. There is currently one FDA-approved drug to treat thyroid eye disease, the drug  Tepezza (teprotumumab), made by Horizon Therapeutics.

Meanwhile, the second period has been dubbed the stable phase. During this stable period, there is a relief of symptoms. The second stage is typically when patients undergo surgical cosmetic corrections of any eye protrusion or vision issues.

Treatment Options

Currently, there are several treatment options for dealing with the symptoms associated with thyroid eye disease.

Dry Eyes

During the disease’s active phase, the eyelids may tighten and retract, making it difficult to blink properly. If the eyelid isn’t properly closed and the eye’s surface is left exposed, it can dry out and become irritated.

You can help alleviate this with frequent use of lubricating drops, gels, or ointments to help soothe any burning sensation. Instill drops frequently throughout the day. Save the thicker gels and ointments for the nighttime hours. These thicker products tend not to evaporate as quickly but may cause some blurring.

Double Vision

With thyroid eye disease, the muscles responsible for moving the eyes can become swollen and scarred, causing double vision. This may actually go away on its own. If not, there are several different options to try, including:

• Use of prisms in eyeglass lenses
• Eye patching
• Use of steroids to improve eye movements
• Taking the insulin-like growth factor inhibitor medication Tepezza, to quell inflammation
• Undergoing surgery to realign the eyes, once symptoms have been stable for about six months

Eye Protrusion

The eyes can get pushed forward in thyroid eye disease by the accumulation of fluid around fat and muscles. This can sometimes disappear on its own.

When it doesn’t, one option is the use of the drug Tepezza, which has been shown to help eye-bulging resolve in many cases. This medication helps to reduce swelling and inflammation.

There’s also the possibility of undergoing eye decompression surgery, in which some of the socket bone is removed to create more space for the swollen eye tissues. This can not only help you to feel better but also can assist in returning your appearance to what it was previously.

Eyelid Retraction

With thyroid eye disease, the eyelids can get pulled back by scarring and subsequent shortening of the muscles. Those contending with eyelid retraction may deal with dryness, light sensitivity, and sometimes even vision loss.

The retracted eyelids can also show more of the white of the eye and may make it appear as if someone is staring. Once the eyelid positioning has become stable, however, surgery can be performed to reposition the eyelids more normally.

Vision Loss

In a small number of cases, thyroid eye disease may result in vision loss. Some signs that this may be occurring can be:

• Abnormal color vision
• Dimmer-appearing lights
• Less sharp vision

If you notice any signs of vision loss, it’s important to alert your healthcare provider immediately. Sometimes this can be due to eye surface dryness, which can occur if the lids don’t close properly. Dryness can be treated with drops, gels, or ointments.

It’s also possible for the ocular nerve to become compressed if the swollen eye begins to press on this. Use of medication such as anti-inflammatory drops, steroids, or even radiation can be given. Sometimes the healthcare provider may recommend surgery to help take the pressure off the nerve.

Prognosis

Determining how you will ultimately fare with thyroid eye disease depends on your individual case. Some people are fortunate to have mild symptoms, which resolve on their own with minimal treatment. In other cases, patients must contend with symptoms like double vision or retracted lids, which require some surgery.

Cosmetically, it’s more possible than ever to decrease eye bulging with the aid of medication or surgery. The result can be an appearance that you are more comfortable with and closely resembles the look you had previously.

Fortunately, only a small number of people, about 10% to 20%, deal with thyroid eye disease in its most severe form. Most never deal with related vision loss. Only occasionally is it necessary for patients to undergo surgery and other measures to preserve their vision.