Thyroid Eye Disease (TED), also known as Graves’ orbitopathy, is an autoimmune disorder characterized by proptosis (protruding or bulging eyes), inflammation, tissue remodeling, fat expansion, and fibrosis in the orbit (eye socket) (1). Too often, though, the eye changes associated with TED go unnoticed until they become more serious (2). One of the best ways to avoid that progression is to ensure early detection through regular, comprehensive eye exams. This article explains how regular eye examinations help detect early signs of TED, why catching it early is important, what tests are to be taken, and how you can work with your eye and thyroid teams to avoid complications and ensure timely intervention.
Why Regular Eye Exams are Important in Thyroid Eye Disease
A common misconception is that TED is invariably associated with thyroid issues, and both are always co-manifested. But in reality, TED can sometimes begin before thyroid hormone abnormalities are obvious. Because TED affects tissues in the orbits (sockets containing the eyes) such as muscles, fat and connective tissues, many changes are subtle at first, such as slight bulging, light sensitivity, mild double vision, minor eyelid retraction, redness, pain, dry eyes and inflammation. These early signs are easy to overlook when inexperienced and can only be evaluated in their proper context by an expert exam. Without regular monitoring, the disease may progress into an active/inflammatory phase, leading to more severe problems such as optic-nerve compression, corneal exposure, permanent muscle or tissue damage and serious vision issues. Hence, prevention or early intervention is much more effective than treating late complications. Based on general prevalence up to 1 in 3 people with Graves’ disease have the risk of developing TED, exemplifying the need for constant monitoring.
What a “Regular Eye Exam” Means in the Context of TED
A standard vision check (for glasses or contact lenses) is a start and if there is a history of TED, an enhanced approach can be added. Apart from checking vision, measurement of eye bulging (exophthalmometry) to detect even small forward shifts, assessment of eye-movements and binocular alignment (to catch early double vision/diplopia), visual acuity and color vision testing (to detect optic nerve stress), visual-field testing (to check for pressure on optic nerve or peripheral vision loss), review of eyelid function, eyelid closure (to protect the cornea), dryness, tearing, exposure risk, discussion of thyroid status, smoking history, and other risk factors are to be included (3). If any of these symptoms are detected, additional testing through imaging, such as a CT or MRI scan of the orbit, especially if early signs suggest tissue swelling or nerve involvement, can be recommended. Even if thyroid labs are normal, that does not guarantee that TED is absent, and eye exams must remain part of standard care even with well-controlled thyroid disease.
Early Detection Helps Avoid Advanced Complications
Here are some of the major complications of advanced TED and how regular monitoring and early intervention help to reduce them (4).
Optic Nerve Compression and Vision Loss
Swelling of the tissues in the orbit can lead to the optic nerve becoming compressed. This can cause permanent vision loss if not detected and managed in time. Some of the early signs of optic nerve compression are color-vision changes, mild peripheral field defects and a subtle decrease in visual acuity. With regular eye exams, these warning signs can trigger imaging and referral to an oculoplastic specialist or orbital team for prompt treatment.
Corneal Exposure & Ulceration
TED causes eyelid retraction, resulting in the inability to fully close the eyelids, leading to the front surface of the eye being prone to dryness, subsequent ulceration and damage. Regular eye exams can detect changes in eyelid closure, lagophthalmos, decreased tear production, and altered tear composition. Early treatment with lubrication, eyelid taping, and protective measures can prevent corneal ulcers or scarring, while late recognition may require intensive surgery and risk permanent vision loss.
Diplopia (Double Vision) and Muscle / Tissue Changes
Inflammation in the extraocular muscles may lead to misalignment and persistent diplopia. If it were diagnosed at an early stage, muscle swelling is still reversible. Routine eye exams can track motility and alignment, facilitating both earlier medical therapy (steroids, biologics) or strabismus monitoring as indicated. As with the above changes, a delay in detection makes mechanical and surgical correction more complex.
Cosmetic / Functional Impact
In addition to the physiological consequences, bulging eyes, eyelid changes, and asymmetry can lead to psychosocial distress, eye comfort issues, and aesthetic problems. Hence, regular eye examinations are important for early detection, allowing for simpler treatments and helping to avoid complex procedures such as decompression, eyelid or cosmetic surgery.
When and How Often to Get Eye Exams
The frequency of exams depends on your preponderance and for those with a thyroid disorder (especially Graves’ disease), at least yearly comprehensive eye exams are strongly recommended. If there are early signs of TED (even mild), or a known history of TED, the specialist may advise exams every 3-6 months during the active phase. Accompanying high-risk habits like smoking, a history of radioiodine therapy etc., warrant closer monitoring. It is imperative to seek prompt attention when noticing new TED-related symptoms such as new bulging, double vision, vision changes, eyelid closure problems, or eye pain.
Integrating Eye Exams with Thyroid Testing and Multi-disciplinary Eye Care
Eye exams for TED do not happen in isolation and are part of a broader holistic treatment regimen involving several specialists such as endocrinologists for managing thyroid hormone levels, autoantibodies and radioiodine therapy, and an ophthalmologist/oculoplastic specialist for monitoring orbital and eyelid changes. In addition, an optometrist may do routine eye screenings and refer when orbital signs appear. Patients should also track their own symptoms (dryness, pain, motion restriction, bulging) and modify lifestyle factors such as smoking.
Regular Eye Exams Enable Better Outcomes
When dealing with TED, early detection matters more than ever and regular, comprehensive eye exams allow the detection of early signs and symptoms before they evolve into serious complications. By combining routine ophthalmic monitoring with thyroid control and lifestyle modifications, many patients can avoid advanced surgical intervention, preserve vision, and experience better comfort and appearance. It is important to remember that TED is not just about vision but it is also about the tissues behind and around the eye. So, a “normal” thyroid test is not sufficient to rule out eye-related changes. Early symptoms or subtle changes matter and reporting them promptly to the care team makes all the difference.
If you have a thyroid disorder or are experiencing any eye changes, even mild ones, do not hesitate to schedule an appointment with Dr. Raymond Douglas.
References
- Shah SS, Patel BC. Thyroid Eye Disease. StatPearls. Treasure Island (FL)2025.
- Ramesh S, Zhang QE, Sharpe J, Penne R, Haller J, Lum F, Lee AY, Lee CS, Pershing S, Miller JW, Lorch A, Hyman L, Iris Research Analytic Center C. Thyroid Eye Disease and its Vision-Threatening Manifestations in the Academy IRIS Registry: 2014-2018. Am J Ophthalmol. 2023;253:74-85. Epub 20230517. doi: 10.1016/j.ajo.2023.04.013. PubMed PMID: 37201696; PMCID: PMC10525031.
- Men CJ, Kossler AL, Wester ST. Updates on the understanding and management of thyroid eye disease. Ther Adv Ophthalmol. 2021;13:25158414211027760. Epub 20210630. doi: 10.1177/25158414211027760. PubMed PMID: 34263138; PMCID: PMC8252358.
- Dhaliwal NK, Razzaq L. The Management of Thyroid Eye Disease: From Current Practice to Future Perspectives. Cureus. 2025;17(6):e86483. Epub 20250621. doi: 10.7759/cureus.86483. PubMed PMID: 40693095; PMCID: PMC12278685.
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