Thyroid eye disease

Thyroid Eye Disease (TED)

Thyroid Eye Disease (TED) — also known as Graves’ orbitopathy or thyroid-associated orbitopathy — is an autoimmune condition that affects the tissues around the eyes. It most often occurs in people with an overactive thyroid (Graves’ disease), but can also be seen in those with normal or underactive thyroid function.

TED can cause eye discomfort, changes in appearance, and, in more severe cases, double vision or vision loss. While the condition can be distressing, expert care can help control the disease and, where needed, restore both function and appearance.

Symptoms of Thyroid Eye Disease

Symptoms can vary widely, but common signs include:

Bulging eyes (proptosis)
Puffy or swollen eyelids
Eyelid retraction (eyes look wide or staring)
Gritty, dry, or watery eyes
Double vision
Eye pressure or pain
Difficulty closing the eyes
Vision changes (in more advanced cases)

TED may affect one or both eyes and often fluctuates in severity over time.

The Phases of TED

TED typically follows two main phases:

1. Active (Inflammatory) Phase

This early phase is marked by inflammation, swelling, and discomfort. It can last from several months up to two years. During this stage, the focus is on reducing inflammation and protecting vision.

Management during the active phase may include:

Lubricating eye drops and gels for dryness or exposure
Anti-inflammatory treatments such as steroids
Temporary measures to manage double vision or eyelid changes

Smoking cessation is especially important, as smoking is known to worsen TED and reduce the effectiveness of treatment. Additionally, stable and well-managed thyroid function, coordinated with an endocrinologist, is vital to improving outcomes and reducing flares.

2. Inactive (Fibrotic) Phase

Once the inflammation settles, the disease enters a quiet or “burned out” phase. At this point, some residual effects may remain — such as prominent eyes, double vision, or eyelid asymmetry.

This is when surgical rehabilitation can be considered to improve comfort, restore appearance, and correct any lasting visual disturbance.

Surgical Rehabilitation for TED

Surgery is usually performed in stages, depending on the patient’s needs and priorities. Procedures may include:

Orbital decompression – to reduce eye bulging by expanding the eye socket
Strabismus (eye muscle) surgery – to correct double vision
Eyelid surgery – to improve eyelid retraction or restore symmetry and comfort

Miss Ting is a specialist oculoplastic surgeon, fully trained in this complex multi-step approach. She provides tailored surgical planning based on each patient’s specific anatomy and concerns, aiming for both functional improvement and natural-looking results.

Emerging Treatments: Teprotumumab

Teprotumumab is a new, targeted medication that has shown promising results in reducing inflammation, bulging, and double vision in selected patients with active TED. It is not yet routinely available in the UK, but Miss Ting has first-hand experience with teprotumumab, having trained in the United States where it was first introduced.

She currently leads thyroid eye disease drug trials at the Royal Free Hospital, placing her at the forefront of developments in TED care. Where appropriate, she can advise on clinical trial participation or future access to this treatment as it becomes more widely available.

Expert, Individualised Care

Thyroid Eye Disease affects both appearance and quality of life. Miss Ting works closely with endocrinologists and other specialists to provide truly joined-up care. Her approach is thoughtful, evidence-based, and always tailored to each patient's unique journey with TED.

Next Steps

If you have been diagnosed with TED or are experiencing symptoms suggestive of the condition, Miss Ting offers comprehensive assessment and a full range of medical and surgical options to support your recovery. Early input can make a significant difference — please get in touch to arrange a consultation.

Thyroid eye disease