Thyroid Eye Disease Program at the Scheie Eye Institute

Scheie Eye Institute’s Thyroid Eye Disease Program — the first of its kind in the Mid-Atlantic region — offers advanced, comprehensive care for patients with thyroid eye disease (TED). Patients will see two University of Pennsylvania physicians with unique areas of expertise: oculoplastics and orbital specialist César A. Briceño, MD, and neuro-ophthalmic and strabismus specialist Madhura Tamhankar, MD. Both physicians will evaluate each patient and devise an appropriate treatment plan. Patients can also receive on-site rehabilitative therapies, including decompression surgery, eye muscle surgery and eyelid surgery. 

Frequently-asked Questions about Thyroid Eye Disease

What is thyroid eye disease (TED)?

TED is an autoimmune disease in which the eye muscles and fatty tissue behind the eye become inflamed. This inflammation can push the eyes forward (“staring” or “bulging”) or cause the eyes and eyelids to become red and swollen. In some individuals, the inflammation may involve the eye muscles, causing the eyes to become out of line, leading to double vision. In rare cases, TED can cause blindness from pressure on the nerve in the back of the eye or ulcers that form on the front of the eye (cornea).

TED is an autoimmune disease, meaning that the inflammation and scarring are caused by an attack from the body’s immune system. TED is primarily associated with an over-active thyroid gland due to Graves’ disease, although it can rarely occur in patients with an under-active or normally functioning thyroid gland. About a quarter of patients with Graves’ disease develop TED before, during or after the diagnosis of a thyroid disorder. TED is also known as Graves’ orbitopathy (GO) or Graves’ eye disease (GED).

Smokers are two to eight times more likely to develop TED.

What are the symptoms of thyroid eye disease?

The most common symptoms of TED include:

  • Bags under the eyes
  • Blurred/double vision
  • Change of the eyes’ appearance (usually staring/bulging)
  • Difficulty moving the eyes
  • Dry or watery eyes
  • Gritty feeling in the eyes
  • Low tolerance of bright lights
  • Pain in or behind the eye — especially when looking up, down, or sideways
  • Redness of the lids and eyes
  • Swelling or fullness in one or both upper eyelids

If you develop any of the following symptoms, see your doctor immediately:

  • You have blurred vision that does not improve by blinking or covering either eye.
  • You become aware that colors do not appear as bright as usual, or there is a difference in how bright colors seem when you compare one eye with the other.
  • You have double vision.
  • Your symptoms grow increasingly worse over a period of several days or weeks.

TED is often difficult to diagnose, with patients sometimes treated for conjunctivitis, allergy or hay-fever for months before an official diagnosis is made. Itchy or sticky eyes are not typical symptoms of TED.

Signs that your condition may be due to TED include:

  • Symptoms occur in the wrong season for hay-fever.
  • Symptoms include eye ache/pain, especially with eye movement.
  • You develop double vision. This is serious and is likely from TED.

What treatments are available?

When symptoms of TED develop, they can be progressive for the first six to twelve months. So, early diagnosis and treatment is important to prevent the condition from worsening. For mild TED, artificial tear drops will help with dry eye relief. Selenium supplements can also be beneficial. For severe TED, steroids and/or orbital radiotherapy may be considered. Some patients with TED are left with permanent double vision or a change in the appearance of their eyes, for which surgery may be recommended. Surgery is typically performed as a part of rehabilitative therapy once the inflammation has resolved and may involve:

  • Decompression surgery, which removes bone and soft tissue from behind the eye to create more space.
  • Eye muscle surgery, which corrects severe double vision.
  • Eyelid surgery, which improves the appearance and function of the eyelids.

Other recommendations for TED patients can include:

  • Prism glasses for double vision
  • High-dose steroid medications and/or radiation to improve inflammation and double vision
  • Support groups/counseling to address the social and psychological effects of the appearance of the eyes

Patients can control the severity of TED symptoms by:

  • Quitting smoking. TED treatments are less effective for current smokers.
  • Taking selenium supplements, which are available over the counter.
  • Maintaining normal levels of thyroid hormones. Test your blood regularly and follow your doctor’s instructions, including taking prescribed medications.

Can thyroid eye disease affect my quality of life?

TED can impact your social and psychological well-being. You may experience mood swings, anxiety or irritability if you have fluctuating thyroid levels. These symptoms will likely persist until your hormone levels stabilize. Additionally, you may experience anger or a decline in self-confidence as a result of the change in the appearance of your eyes. These symptoms often improve with TED treatment or surgery. Contact your doctor for more information about support groups and other strategies to help manage these symptoms.

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