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Red, puffy eyes are a common symptom of seasonal allergies. But sometimes they signal a thyroid issue. Here’s help spotting the difference.
It’s easy to blame eye irritation on seasonal allergies. But sometimes dry, red, swollen eyes can signal something more serious. One culprit to be especially cautious about is thyroid eye disease, which doctors frequently shorten to TED. The condition is also known as Graves’ ophthalmopathy, or simply Graves’ eye disease.
Here’s help spotting the signs of TED or Graves’ eye disease — and the treatments that your optometrist may recommend.
Thyroid Eye Disease and Graves’ Eye Disease, Explained
It’s probably not surprising to learn that Graves’ eye disease, or TED, usually develops in people who have Graves’ disease. Graves’ disease is an autoimmune disorder that often leads to an overactive thyroid gland, known as hyperthyroidism. TED often appears at the same time as hyperthyroidism, or within about six months of diagnosis.
A quick explanation of Graves’ disease: As with any autoimmune disorder, the condition means that the body’s natural immune (or defense) system can’t tell the difference between your own cells and foreign cells, according to Johns Hopkins Medicine.
The result is that the body attacks normal cells by mistake. In the case of Graves’ disease, the body targets the thyroid gland, speeding it up, or making it overactive. That’s hyperthyroidism.
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How Hyperthyroidism Affects Your Eyes
The hormones secreted by the thyroid gland affect your metabolism, and that understandably has an impact on many of your bodily functions and organs. The imbalance in your immune system can cause inflammation of the muscles and fat tissue around the eyes.
The result is thyroid eye disease, explains Ishan Gandhi, O.D., a Suffolk, Virginia–based optometrist and clinical ambassador for America’s Best Contacts & Eyeglasses.
More than 1 in 3 people with Graves’ disease develop TED, according to the National Institutes of Health.
Is It Thyroid Eye Disease or Allergies?
It can sometimes be tricky to tell the difference between TED and run-of-the-mill allergic reactions to pollen, ragweed, and the like. “Allergies and TED have some common symptoms, such as excessive dryness, watering of the eyes, and redness of the eyelids,” Dr. Gandhi explains.
But TED has other symptoms that allergies normally don’t cause, including:
- Bulging eyes
- Double vision
- Swelling of your eyelids, which can lead to an inability to close your eyes all the way
- Light sensitivity
- A gritty sensation in your eyes
Left undiagnosed and untreated, the symptoms may get worse and lower your quality of life, according to Dr. Gandhi. They may even threaten your eyesight. So it’s important to visit your eye doctor annually — and to make an appointment with them immediately if you notice any of the symptoms above.
“Having an annual comprehensive eye examination can help your doctor detect the underlying cause of your symptoms and treat your symptoms for relief,” Dr. Gandhi says.
How Your Eye Doctor Detects TED
If you’ve already been diagnosed with hyperthyroidism, your eye doctor may confirm a TED diagnosis by checking for swelling and enlargement of the eye muscles. (Remember to keep your eye doctor up to date on your medical history. For more information, read “4 Things Your Optometrist Needs to Know About Your Health” here.)
If you haven’t been diagnosed with hyperthyroidism and you’re experiencing the above visual symptoms, your eye doctor will refer you to your primary care physician for testing. Your thyroid hormone levels can be checked through a series of blood tests. You may also need a CT (computed tomography) or MRI (magnetic resonance imaging) scan of your eye muscles.
How Thyroid Eye Disease Is Treated
Unfortunately, TED cannot be cured. But early treatment can help prevent permanent damage to your eyes.
The treatment itself varies according to your symptoms, says Dr. Gandhi. Thankfully, many of the symptoms are mild and easy to manage:
- Dry, red eyes can be treated with a warm compress and lubricating drops.
- Swelling in the eyes can be improved by temporary treatment with oral steroids.
- If double vision is an issue, your doctor can prescribe glasses containing prisms.
But some symptoms may require corrective surgery to restore eye function or prevent permanent damage.
- If glasses containing prisms don’t correct your double vision, surgery may be an option.
- If tight, swollen eyelids make it hard to close your eyes fully, your doctor may recommend eyelid surgery.
- If your eyesight is in jeopardy due to bulging eyes or other swelling, you may need a type of surgery known as orbital decompression to relieve pressure on your optic nerve and give your eyes room to move back to their normal position.
Of course, a big part of treating TED is treating your hyperthyroidism in general. That’s why it’s important to follow your doctor’s treatment plan, including taking any prescribed medications as instructed.
“Once the thyroid is treated and returned to normal levels, the eyes must be monitored on a regular basis, and your symptoms may need to be treated,” Dr. Gandhi says.
If you receive a TED diagnosis, your optometrist will contact your primary care physician or internist to coordinate treatment, Dr. Gandhi says. They can work hand in hand to monitor your condition and quickly address any threats to your vision.