Early diagnosis and treatment of TED is important as sometimes damage can start before visible symptoms appear3-6. Understanding how damage manifests is important in the timely diagnosis of TED.
Upper eyelid retraction is 1 of the most common symptoms of TED.8 Retraction develops from levator and Müller muscle inflammation and fibrosis, or from levator muscle overaction caused by inferior rectus restriction.7,8
Proptosis is caused by the expansion of the orbital fat and muscles behind the eyes. Proptosis is 1 of the most common symptoms of TED.8
Erythema (redness) and edema (swelling) of the eyelids are common symptoms of TED.1,8
Eyelid retraction combined with proptosis can lead to reflex tearing.7
TED can cause an increase in the orbital soft tissue volume, which leads to higher pressure within the inexpandable bone cavity.8
The conjunctiva that covers the sclera swells, making the eye look red and puffy. Fluid can build up under the membrane, making it look like there is a big, red blister in the eye.8,9
Also known as periocular dermatitis or periorbital dermatitis, eyelid erythema presents with a scaly, erythematous eruption of the upper and lower eyelids, resulting in swollen eyelids that often itch, burn, sting, and look red.8,10
Inflammation of the extraocular muscles is a common manifestation of TED that can lead to restricted eye movements and proptosis. This can be caused by rectus muscle swelling or by fibrotic changes.11
Strabismus, also known as misalignment of the eyes, can lead to diplopia and interfere with a patient’s ability to work, read, drive, and complete other daily functions.12
Swelling of the small, pink, globular nodule at the inner corner (the medial canthus) of the eye.8,13
In 1 study of patients diagnosed with both TED and Graves’ disease, orbital MRI revealed extraocular muscular swelling in 71% (n=17) of patients that showed no visible signs of TED5
This swelling could explain why some TED patients first experience nonvisible symptoms before presenting with visible signs8
Dry eyes and grittiness are frequently overlooked symptoms of TED.15 These symptoms are often misdiagnosed as dry eye disease, allergies, or conjunctivitis.16
The feeling of pain or pressure behind the eye. It can be caused by a variety of conditions and is usually described as a deep, dull ache behind or within the eye itself.8,17
Diplopia is caused by swelling and inflammation of the extraocular muscles and typically restricts the movement of the eye, causing double vision. The most frequently involved muscle is the inferior rectus.1
Some patients can’t see things clearly in either 1 or both eyes. This can make it difficult to perform daily activities.18
Some patients may feel like a piece of dust or dirt is stuck in their eye even though nothing is really present—a phenomenon known as “foreign body sensation.”19
TED can cause dryness, which leads some patients’ eyes to feel itchy. Patients will often use lubricating eye drops for temporary relief.20
Photophobia, or light sensitivity, often occurs in TED patients when the upper eyelid retracts, resulting in corneal exposure.7
As a result of inflammation, TED patients can experience the feeling of pressure or pain. This can feel like a dull ache and/or sharp, shooting pains.8,17
Also known as acquired color vision deficiency, color vision loss can be a result of damage to the optic nerve, and there is a risk of vision loss. Colors may not appear as bright as they once were, or there could be a difference in the brightness of colors when comparing one eye with the other. In rare cases, some patients may become color blind.18,21-23
In some cases, patients may notice some vision loss, or they may experience complete vision loss. This occurs because TED can cause swelling behind the eye that pushes down on the optic nerve. If this happens, emergency surgery may be needed to save the patient’s vision. Optic nerve damage in TED patients can lead to blindness, but it’s very rare.11,23,24
As a thyroid endocrinologist, I am in a position to identify signs and symptoms of TED early, especially in those already facing thyroid issues. By detecting and addressing TED sooner, we can truly make a difference in helping our patients feel better and restoring their quality of life."
Symptoms may resemble those of dry eye disease, allergies, or conjunctivitis16
TED is also linked to thyroid conditions such as Graves’ disease or Hashimoto’s disease25
When making a differential diagnosis, it is important to screen patients with these other conditions for TED3,16,25
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