Thyroid Eye Disease: Diagnosis & Treatment

Learn how thyroid eye disease is diagnosed, what tests may be used, and how treatment varies according to disease activity and severity.

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Thyroid Eye Disease: Diagnosis & Treatment

Diagnosing Thyroid Eye Disease involves more than checking thyroid hormone levels. An eye-care professional evaluates the appearance and function of the eyes, assesses symptoms and vision, and may use additional testing to determine how active and severe the disease is.

Treatment depends on these findings. Mild disease may require symptom relief and observation, while active or more severe disease may require medication or other interventions. In sight-threatening cases, urgent treatment is necessary.

How Is Thyroid Eye Disease Diagnosed?

TED is usually diagnosed through a combination of medical history and an eye examination.

  • Thyroid disease or previous thyroid treatment
  • Changes in eye appearance
  • Dryness or irritation
  • Eye pain or pressure
  • Double vision
  • Changes in vision
  • Changes in symptoms over time
  • Smoking or tobacco exposure
  • Previous treatments for TED

The examination then looks at how the eyes and surrounding tissues are functioning.

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What Does an Eye Examination for TED Involve?

The exact examination varies depending on your symptoms and medical history.

An eye-care professional may assess:

Visual acuity testing measures how clearly you can see. Additional testing may be used when there is concern about optic nerve function.

Changes in color vision can sometimes provide an important clue when the optic nerve is under pressure.

TED can cause the muscles controlling eye movement to become swollen or stiff. This can make certain eye movements difficult and can contribute to double vision.

The position of the upper and lower eyelids may be examined, including whether the eyelids completely close during blinking and sleeping.

The cornea and other surface tissues may be examined for dryness, irritation, or exposure-related damage.

The amount of forward movement of the eye, known as proptosis, may be assessed.

These findings help establish how TED is affecting the individual patient.

Frequently Asked Questions

Blood tests may be used to evaluate thyroid function and help assess the underlying thyroid disorder.

Depending on the circumstances, thyroid-related antibody testing may also be considered.

Eye disease and thyroid disease are related, but they are not identical. A person can have significant eye symptoms even when thyroid hormone levels are not currently abnormal.

Not every patient needs imaging.

When additional information is needed, an orbital CT or MRI may help doctors examine the tissues and muscles around the eye. Imaging can be particularly useful when the diagnosis is uncertain, the disease is more severe, or the clinician needs additional information for treatment planning.

The decision to obtain imaging depends on the patient’s examination and clinical circumstances.

One of the most important considerations in TED is whether the disease is active or inactive.

During active disease, inflammation and swelling are occurring or changing. Treatment may therefore focus on controlling inflammation and preventing further progression.

Once the inflammatory activity has settled, some patients may be left with changes such as persistent eye prominence, eyelid retraction, or double vision. These residual changes may be approached differently, including possible rehabilitative surgery.

Mild TED often focuses on relieving symptoms and reducing factors that can make the disease worse.

Depending on the patient’s symptoms, management may include:

  • Lubricating eye drops
  • Lubricating gels at night when appropriate
  • Sunglasses for light sensitivity
  • Measures to protect the ocular surface
  • Elevating the head while sleeping to reduce swelling
  • Prisms in glasses when appropriate for double vision
  • Avoiding cigarette smoke
  • Maintaining appropriate thyroid hormone control

Treatment should be tailored to the symptoms and examination findings.

Moderate-to-severe or active disease may require medical treatment directed at the underlying inflammatory process.

Depending on the individual situation, possible treatments include:

  • Intravenous or oral corticosteroids
  • Biologic or immune-modulating medications
  • Other immunosuppressive treatments
  • Orbital radiation in selected circumstances
  • Surgical treatment when appropriate

There is no single treatment that is right for every patient. Treatment selection depends on disease activity, severity, symptoms, previous treatments, other medical conditions, potential medication risks, and access to appropriate therapies.

Biologic medicines are therapies designed to target specific parts of the immune system.

Teprotumumab is an insulin-like growth factor-1 receptor (IGF-1R) inhibitor that has been studied extensively in TED and is approved for TED in the United States. Clinical evidence has shown benefits in areas such as eye prominence and double vision in appropriately selected patients.

Treatment options continue to evolve. In June 2026, the U.S. Food and Drug Administration approved veligrotug-vvze (Lumvoa) for thyroid eye disease, making it another IGF-1R-targeting treatment option in the United States. Availability and regulatory approval can differ between countries.

These medicines are not appropriate for every patient, and their potential benefits and risks need to be evaluated individually.

Corticosteroids can reduce inflammation and are an established treatment for active, moderate-to-severe TED.

Intravenous corticosteroid treatment is generally favored over high-dose oral corticosteroids in many treatment guidelines because of differences in effectiveness and adverse effects. The exact regimen depends on the patient’s disease and overall health.

Because corticosteroids can have significant systemic effects, they require appropriate medical supervision.

Treating the underlying thyroid condition is an important part of overall care, but it does not necessarily reverse TED.

The thyroid and eye conditions need to be managed together. A patient may require both thyroid management and specific treatment for the eyes.

Maintaining stable thyroid hormone levels and avoiding tobacco exposure are important aspects of TED care.

Selenium supplementation has been studied in patients with mild TED, particularly in areas where selenium deficiency is more common.

However, supplementation is not automatically appropriate for everyone. Whether it is useful depends on factors such as the severity of eye disease, nutritional status, geography, and the advice of the treating clinician.

Patients should not begin high-dose supplements without discussing them with a healthcare professional.

Surgery is not usually the first treatment for active inflammatory TED.

However, surgery can become important when:

  • TED has caused persistent structural changes
  • Eye prominence remains significant
  • Double vision persists
  • Eyelid changes remain after disease activity has settled
  • The eye cannot be adequately protected
  • Vision is threatened by severe orbital disease

Surgical approaches may include orbital decompression, eye-muscle surgery for double vision, and eyelid surgery. These procedures are generally considered according to the patient’s specific anatomy, symptoms, and disease stage.

A small proportion of patients develop sight-threatening disease, particularly when swelling around the optic nerve causes compressive optic neuropathy.

Urgent assessment is warranted for symptoms such as:

  • Reduced vision
  • Reduced color vision
  • Rapidly worsening visual function
  • Severe exposure of the cornea
  • Significant new or worsening eye symptoms

Sight-threatening TED requires urgent specialist treatment.

Continue Learning

What Is Thyroid Eye Disease?

Learn about the causes, symptoms, risk factors, and progression of TED.

Living With Thyroid Eye Disease: Symptoms, Surgery & Long-Term Care

Learn about managing persistent symptoms, surgical options, and long-term monitoring.

Medical Disclaimer

The information on this page is provided for general educational purposes and is not a substitute for a professional eye examination, diagnosis, or individualized medical advice. Cataract treatment and surgical decisions depend on each patient’s eye health, medical history, visual needs, and other individual factors. If you have sudden or significant changes in vision, severe eye pain, or other concerning symptoms, seek prompt medical attention.

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