Autoimmune orbital inflammation in thyroid disease
Thyroid Eye Disease (Graves' Orbitopathy) Treatment in Los Angeles
Bulging eyes, double vision, and eyelid retraction from thyroid eye disease can dramatically affect your appearance and vision. Some cases can even threaten your sight. Our neuro-ophthalmology practice in Los Angeles specializes in managing thyroid eye disease — from monitoring mild cases to coordinating treatment for sight-threatening complications.
What is Thyroid Eye Disease?
Thyroid eye disease (TED), also called Graves' orbitopathy or Graves' ophthalmopathy, is an autoimmune inflammatory condition that affects the tissues around the eyes — the muscles, fat, and connective tissue within the orbit. It is most commonly associated with Graves' disease (hyperthyroidism) but can also occur with Hashimoto's thyroiditis or even normal thyroid function. TED causes the eye muscles and orbital fat to swell, leading to proptosis (bulging eyes), eyelid retraction, double vision, and in severe cases, compressive optic neuropathy with vision loss.
Symptoms of Thyroid Eye Disease
- Bulging or protruding eyes (proptosis / exophthalmos)
- Eyelid retraction — a "staring" or "startled" appearance
- Double vision from swollen eye muscles
- Eye redness, tearing, and grittiness
- Swelling and puffiness around the eyes
- Difficulty closing the eyes completely, especially during sleep
- Light sensitivity
- In severe cases: decreased vision, color vision changes (compressive optic neuropathy)
Common Causes of Thyroid Eye Disease
- Autoimmune attack on orbital tissues — same antibodies that cause Graves' hyperthyroidism
- Graves' disease (the most common association)
- Hashimoto's thyroiditis
- Euthyroid (normal thyroid) — in a minority of cases
- Smoking — the strongest modifiable risk factor, dramatically worsens TED
- Radioactive iodine treatment for hyperthyroidism (can temporarily worsen TED)
How We Evaluate Thyroid Eye Disease
Evaluation includes measurement of proptosis (Hertel exophthalmometry), assessment of eye movements and double vision, evaluation of eyelid position and closure, and examination of the optic nerve. Clinical Activity Score (CAS) determines whether the disease is in an active inflammatory phase. Visual field testing and OCT assess for compressive optic neuropathy. CT or MRI of the orbits shows enlarged eye muscles and orbital inflammation. Thyroid function tests and thyroid antibody levels are checked.
Treatment Options
Treatment depends on the severity and activity of the disease. Mild cases may require only lubricants and monitoring. Teprotumumab (Tepezza) is an FDA-approved targeted biologic that has shown dramatic improvement in proptosis and double vision for active TED. For severe active disease, intravenous corticosteroids are used. Once the disease stabilizes (inactive phase), surgical rehabilitation may include orbital decompression, strabismus surgery, and eyelid surgery — performed in that specific sequence.
- Smoking cessation — the most important modifiable factor
- Selenium supplementation for mild, active disease
- Teprotumumab (Tepezza) — FDA-approved targeted therapy for active TED
- Intravenous corticosteroids for moderate-to-severe active disease
- Orbital radiation therapy in select cases
- Orbital decompression surgery for severe proptosis or compressive optic neuropathy
- Strabismus surgery for persistent double vision after the active phase
- Eyelid surgery for retraction and cosmetic rehabilitation
- Lubricating eye drops and ointments for surface irritation
Why Choose Dr. Ghiam for Thyroid Eye Disease
- Neuro-ophthalmologist with expertise in orbital disease and compressive optic neuropathy
- Ability to monitor for sight-threatening complications (optic nerve compression)
- Experience with both medical management and surgical planning
- Strabismus surgery expertise for TED-related double vision
- Coordination with endocrinology and oculoplastics for comprehensive care
Thyroid eye disease can threaten vision through compressive optic neuropathy — a condition that requires urgent recognition and treatment. A neuro-ophthalmologist monitors for this complication, manages the double vision and strabismus that commonly accompany TED, and coordinates the multi-stage surgical rehabilitation when needed.
Get Expert Help for Thyroid Eye Disease
If you have thyroid disease and are experiencing eye changes — bulging, double vision, redness, or vision loss — early evaluation can prevent complications. Contact our Los Angeles office today.