The Link Between Thyroid Eye Disease and Glaucoma: Risks, Prevention, and Management
Explore why thyroid eye disease raises glaucoma risks, how to recognize symptoms, and steps for prevention and comprehensive management.
What’s the Connection Between Thyroid Eye Disease and Glaucoma?
Thyroid eye disease (TED) is a chronic autoimmune condition that causes inflammation of the muscles and fatty tissues around the eyes. One important but sometimes overlooked complication is its increased risk for glaucoma—a serious group of eye diseases that can cause permanent vision loss. Understanding this connection is crucial for timely diagnosis and management, potentially preserving sight for those at risk.
Understanding Thyroid Eye Disease (TED)
TED, sometimes referred to as Graves’ ophthalmopathy or Graves’ eye disease, is closely associated with abnormal thyroid function—though it can occur even in those with apparently normal thyroid hormone levels.
- Autoimmune origin: TED occurs when the immune system mistakenly attacks tissues around the eyes.
- Prevalence: About one in three people with Graves’ disease will develop TED, but TED can occur with other thyroid disorders or even with normal thyroid activity.
The areas mainly affected in TED are:
- Eye muscles
- Connective tissue behind the eyeball (orbital tissues)
This can result in a variety of uncomfortable or serious symptoms, including:
- Dry, gritty, or irritated eyes
- Redness and excessive watering
- Puffy, swollen eyelids
- Bulging eyes (proptosis), which may prevent eyelids from fully closing
- Light sensitivity
- Double vision (diplopia)
As the condition progresses, individuals may face more severe complications like corneal ulcers or even vision loss.
Common Complications of TED
- Corneal ulcers: Resulting from dryness and incomplete eyelid closure.
- Vision loss: Due to optic nerve involvement or high pressure within the eye.
- Diplopia (double vision): Resulting from muscle inflammation.
What is Glaucoma?
Glaucoma encompasses a group of eye diseases linked by damage to the optic nerve. This damage is often, but not always, associated with increased pressure inside the eye (intraocular pressure). Over time, this can impair vision and, without intervention, lead to blindness.
There are several types of glaucoma, but the two most common are:
- Open-angle glaucoma: The most frequent form, progressing slowly and often undetected until vision loss occurs.
- Angle-closure glaucoma: Develops more quickly, often leading to sudden symptoms that require immediate attention.
What others are reading
Can Thyroid Eye Disease Cause Glaucoma?
Multiple research studies show a significantly higher risk of glaucoma among people with TED:
- A 2024 analysis using the National Institutes of Health (NIH) All of Us program found that 29% of individuals with TED also had glaucoma, compared to just 6% without TED.
- Adjusting for age, smoking, and other factors, TED was associated with a 3.3-fold higher risk of developing glaucoma.
- Additional studies indicate that glaucoma in TED tends to progress more rapidly and cause more severe optic nerve damage than in people with glaucoma but without TED.
Why Does TED Increase Glaucoma Risk?
Several mechanisms may explain the connection:
- Orbital inflammation and swelling: TED leads to swollen muscles and tissue behind the eye, which can increase pressure within the eye socket (orbit).
- Impaired fluid drainage: Inflammation can impede the normal flow of aqueous humor—the fluid nourishing the eye—causing intraocular pressure to rise.
- Optic nerve vulnerability: The combination of autoimmune inflammation and high pressure makes the optic nerve more susceptible to damage.
These factors together can trigger glaucoma or worsen its progression, especially if left unmanaged.
Who is at Risk?
Certain people are more prone to both TED and glaucoma:
- People with Graves’ disease: They are at higher risk for TED and, by extension, glaucoma.
- History of thyroid dysfunction: Both hyperthyroidism and hypothyroidism have been linked to increased glaucoma risk.
- Current or former smokers: Smoking increases the chances of developing TED by up to eight-fold and is also a risk factor for glaucoma.
- People undergoing radioactive iodine therapy: This treatment for Graves’ disease may heighten TED risk, especially in those with existing eye symptoms.
- Older adults: Both glaucoma and thyroid dysfunctions are more frequent with age.
How Can You Prevent Thyroid Eye Disease and Glaucoma?
While you cannot entirely eliminate your risk, several strategies can lower the chances of developing TED or glaucoma complications:
- Early detection and management of thyroid disorders: Routine screening and effective control of thyroid hormone levels may reduce TED risk.
- Smoking cessation: Avoiding or quitting smoking is strongly recommended, as it is the most modifiable risk factor for TED.
- Discuss treatment options: If you have Graves’ disease, discuss the risks and benefits of radioactive iodine therapy with your endocrinologist, particularly if you have any eye complaints.
- Routine eye exams: Regular vision testing can catch early signs of both TED and glaucoma, allowing for prompt intervention.
- Monitor for symptoms: Be vigilant for new or worsening eye symptoms, especially if you have known thyroid disease.
It is important to note that there is no known way to prevent glaucoma altogether. Instead, early detection through eye exams is critical to mitigating disease progression and vision loss.
Detection: Recognizing Signs and Getting a Diagnosis
TED Symptoms
- Eye redness or watering
- Swollen or puffy eyelids
- Bulging eyes
- Difficulty closing eyelids completely
- Greater sensitivity to light
- Double vision, especially when looking in certain directions
Glaucoma Symptoms
- Gradual loss of peripheral (side) vision, which typically occurs before central vision loss
- Occasionally, eye pain or headache (especially in angle-closure glaucoma)
- Halos around lights
- Sudden visual disturbances or severe eye pain (seek emergency care)
- Most common types are silent and may go unnoticed for years
How Are TED and Glaucoma Diagnosed?
- Comprehensive eye examination: Includes visual acuity, intraocular pressure measurement, optic nerve assessment, and field testing
- Imaging: Special scans or photographs may be used to visualize swelling and optic nerve integrity
- Blood tests: Check thyroid hormone levels and thyroid antibodies if TED is suspected
- Referral to specialists: An ophthalmologist or endocrinologist can coordinate care and necessary evaluations
Management Strategies: Living With TED and Glaucoma
Proper management aims to prevent vision loss, control symptoms, and improve quality of life. Because TED and glaucoma can interact and worsen one another, comprehensive care is essential.
Management of TED
- Thyroid hormone regulation: Balancing hormone levels is critical, typically with medication.
- Smoking cessation: Strongly advocated for all TED patients.
- Artificial tears or lubricating ointments: Help relieve dryness and discomfort.
- Corticosteroids: Oral or intravenous steroids may reduce inflammation during severe exacerbations.
- Immunosuppressive drugs: Sometimes used for severe cases to control autoimmune activity.
- Specialized surgeries: Procedures may correct bulging eyes, eyelid issues, or double vision.
Management of Glaucoma
- Prescription eye drops: The mainstay of treatment for lowering intraocular pressure.
- Oral medications: Occasionally prescribed for pressure control.
- Laser therapy: Used either to increase fluid drainage or reduce fluid production.
- Surgical interventions: May be required if medications and laser therapies fail.
- Lifelong monitoring: Glaucoma is generally a chronic condition requiring regular follow-up visits.
Multidisciplinary Care
Because TED and glaucoma can both impact eye health and require highly specialized approaches, co-management by an ophthalmologist (for glaucoma and TED-related eye issues) and an endocrinologist (for thyroid disorder management) is beneficial.
Outlook and Prognosis
The long-term outlook for individuals with both thyroid eye disease and glaucoma depends on:
- Speed of diagnosis: Early detection is critical to preventing irreversible vision loss.
- Appropriate management: Adherence to treatment plans and follow-up schedules improves outcomes.
- Control of underlying thyroid disease: Reduces TED flare-ups and may stabilize eye disease progression.
While both TED and glaucoma may lead to serious complications—including blindness—most people can maintain vision and quality of life with coordinated, ongoing care.
Protecting Your Vision: Steps to Take
- Have regular, comprehensive eye exams, especially if you have a thyroid disorder or eye symptoms.
- Report new visual changes, discomfort, or pain to your healthcare provider immediately.
- Discuss smoking cessation programs with your healthcare team.
- Ensure coordination among all treating specialists—thyroid and eye doctors.
Frequently Asked Questions (FAQs)
Is it common to have thyroid eye disease and glaucoma at the same time?
Glaucoma is more common in people with TED compared to the general population—up to 29% in some studies. If you have TED, you should be regularly screened for glaucoma.
Can treating thyroid eye disease prevent glaucoma?
Managing TED lowers inflammation and pressure in the eyes, which may reduce the risk of glaucoma development. However, regular eye exams are still crucial, as prevention is never guaranteed.
Are there lifestyle factors that affect risk?
Yes. Smoking is the most important modifiable risk factor for TED and can complicate both diseases. Maintaining eye and thyroid health through regular care, a healthy lifestyle, and adherence to treatment helps lower the risk of complications.
What symptoms should prompt immediate medical attention?
- Sudden vision changes
- Severe eye pain
- Loss of peripheral vision
- Indications of infection, such as increasing redness, swelling, or discharge
What is the long-term vision outlook?
If TED and glaucoma are diagnosed early and managed appropriately, most patients preserve their vision. Delayed diagnosis or suboptimal management, however, increases the risk of permanent loss.
Key Takeaways
- TED significantly raises glaucoma risk due to inflammatory and pressure effects on the eye.
- Early detection, regular monitoring, and coordinated care are critical to preventing vision loss.
- Smoking is a major modifiable risk factor—quitting helps reduce TED development and progression.
- Open communication among healthcare providers ensures optimal outcomes for individuals at risk.
References
- https://www.healthline.com/health/eye-health/thyroid-eye-disease-glaucoma-link
- https://www.nature.com/articles/6700731
- https://pmc.ncbi.nlm.nih.gov/articles/PMC10188653/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC2708670/
- https://glaucoma.org.au/news-details/news/thyroid-disease-and-glaucoma
- https://glaucomatoday.com/articles/2019-jan-feb/thyroid-eye-disease
- https://getvipcare.com/blog/connection-between-glaucoma-and-other-diseases
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