How Can I Reduce Swelling from Thyroid Eye?

Thyroid eye disease, also known as Graves’ eye disease, is an autoimmune condition in which the body’s immune system attacks the fat and muscle tissue within the eye socket, causing inflammation. Thyroid eye disease is not directly caused by Graves’ disease but arises from the same autoimmune condition that causes Graves’ disease.

Graves’ disease is a condition in which the immune system attacks the thyroid gland, resulting in an overactive thyroid (hyperthyroidism). Hyperthyroidism causes an abnormal increase in the metabolic rate that leads to symptoms such as fast and irregular heartbeat, tremors, fatigue, and weight loss.

Thyroid eye disease develops in approximately 50% of people with Graves’ disease. Thyroid eye disease is associated with hyperthyroidism in 90% of the cases. Approximately 5% of thyroid eye disease patients have an underactive thyroid (hypothyroidism) and 5% have normal thyroid function.

The symptoms of thyroid eye disease include:

Early symptoms:

• Eye redness, pain, and/or itching
• Puffiness of the eyes
• Watering eyes or dry eyes at different times
• Irritation or gritty feeling in the eyes
• Sensitivity to light
• Bulging eyes
• Swelling of eyelids
• Double vision

Late symptoms:

• Protrusion of the eyes and inability to close the eyelids
• Ulcers in the cornea from dryness
• Reduced eye and eyelid movements because of swelling
• Compression of the optic nerve from swollen tissue
• Loss of vision, rarely

Thyroid eye disease is caused because the immune system mistakenly attacks healthy muscle and fat tissue around the eyes. Normally, the immune system attacks foreign organisms and abnormal cells such as cancer cells in the body.

In Graves’ disease, the immune system develops antibodies that attack the thyroid gland. In Graves’ eye disease, the antibodies attack the tissue around the eyes, likely because these tissues contain proteins that appear similar to the proteins in the thyroid gland.

Women are five times more likely than men to be affected by thyroid eye disease, possibly because women are more prone to autoimmune disorders. Smoking, including secondhand smoke, increases the risk for developing thyroid eye disease with more severe consequences.

Thyroid eye disease cannot be cured but can be managed well with appropriate treatment. The inflammation phase may last from six months to two years, but usually, the eyes become stable once normal thyroid levels are maintained.

Some of the changes that come from thyroid eye disease can be surgically corrected once the inflammation subsides, however, some changes may be permanent, depending on the severity of the condition.

Permanent loss of vision is extremely rare but can happen if the disease is left untreated until a late stage of the disease. After treatment, thyroid hormone levels, as well as the condition of the eyes, must be evaluated on a regular basis and treated as needed.

Treatment for thyroid eye disease depends on the symptoms and severity of the condition. The patient first undergoes tests to evaluate thyroid hormone levels. Treatment includes correcting abnormal thyroid levels. The eyes may be checked for the presence of tissue swelling, with CT or MRI scans.

Hyperthyroidism is treated with antithyroid medications that prevent the thyroid gland from producing excess thyroid hormone. Anti-thyroid medications include:

• Carbimazole
• Propylthiouracil

Hypothyroidism is treated with thyroid hormone (thyroxine) tablets to maintain normal levels of thyroxine, which is usually a lifelong treatment.

Thyroid eye disease treatments involve two phases;

• first, when the inflammation is active phases
• second, to correct eye changes after the inflammation has subsided.

Active phase

In January 2020, the FDA approved the first medication to specifically treat thyroid eye disease. The medication is a human-derived monoclonal antibody, which blocks the inflammatory activity of an enzyme known as insulin-like growth factor-1 receptor (IGF-1R) and reduces inflammation in the eyes. The medication approved by FDA is:

• Teprotumumab (Tepezza)

Symptom-based treatments during the active phase include:

• Dry eyes:
  • Use of artificial tears and sunglasses during the day
  • Eye ointments in the night
  • Using eye pads or keeping eyes taped close to protect and keep them moist.
• Swelling:
  • Selenium supplements
  • Sleeping with the head elevated
  • Steroids such as prednisone
  • Radiotherapy to the tissue at the back of the eyes
• Double vision:
  • Use of special glasses with prisms

Remission phase

After remission is achieved, treatments for thyroid eye disease are usually surgical procedures to correct changes to the eyes caused by the disease. Surgeries may include one or more of the following, depending on the patient’s condition:

• Eyelid surgery: Eyelid surgery may be required to reposition the eyelids if the eyeballs are protruding and it is difficult to close the eyes completely.
• Eye muscle surgery: Scar tissue from inflammation can make the eye muscle short and stiff and cause misalignment of the eyes which can result in double vision. Eye muscle surgery is performed to realign the eye muscles and correct double vision.
• Orbital decompression surgery: Swollen tissue at the back of the eyes can compress the optic nerve and compromise vision. Orbital decompression surgery involves the removal of a bone between the eye orbit and sinuses to make space for the swollen tissue and remove the pressure from the optic nerve.