The goal of treating thyroid eye disease (TED) is to reduce symptoms, protect your eyes, and prevent vision loss. TED is an autoimmune condition, meaning the immune system mistakenly attacks healthy tissue. It can cause eye irritation, pain, swelling, bulging eyes, double vision, and changes to your eyes’ appearance.

Your TED care may involve more than one type of healthcare professional, including an endocrinologist and an ophthalmologist.

Your healthcare provider may recommend medication, surgery, local eye care, or lifestyle changes based on your symptoms and eye exam. Below are 11 options.

Insulin-like growth factor-1 receptor (IGF-1R) inhibitors are biologic drugs that target a protein involved in TED. The U.S. Food and Drug Administration (FDA) has approved two options from this class for TED:

• Teprotumumab-trbw (Tepezza) (approved in 2020)
• Veligrotug-vvze (Lumvoa) (approved in 2026)

These drugs are given by intravenous (IV) infusion. Like all medications, teprotumumab-trbw and veligrotug-vvze carry the risk of some side effects.

Common side effects reported with both drugs include:

• Muscle spasms
• Headache
• Nausea
• Diarrhea
• High blood sugar
• Fatigue

Corticosteroids are anti-inflammatory drugs that can help decrease the activity of your immune system. This can lead to less TED-related pain, swelling, and redness. However, corticosteroids generally don’t improve certain TED symptoms like bulging eyes or double vision.

Examples of common corticosteroids include prednisone and methylprednisolone. You can take corticosteroids by mouth or as an IV infusion. IV infusion is generally preferred for active moderate to severe TED.

Local steroid injections may be given around the eye in some situations.

Corticosteroids are usually used for a short time because they can cause side effects. These may include increased blood sugar, high blood pressure, weight gain, mood changes, trouble sleeping, cataracts, glaucoma, and other health problems.

Immunosuppressants are medications that reduce the activity of your immune system. They can help reduce inflammation in the tissues around your eye. Depending on the medication, they may be used alone, with corticosteroids, or when other treatments haven’t worked.

Examples of immunosuppressants that may be used in certain situations to treat TED, sometimes with corticosteroids, include:

• Azathioprine (Imuran)
• Cyclosporine
• Mycophenolate (CellCept or Myfortic)
• Rituximab (Rituxan)
• Tocilizumab (Actemra)

Some of these medications are used off-label for TED, meaning the FDA hasn’t specifically approved them to treat the condition. Your healthcare provider can explain why one of these drugs may be considered and what side effects or risks to expect.

Lubricating eye drops can help relieve dry, irritated eyes. Many people with TED use artificial tears during the day and thicker gels or ointments at night.

There are many options for lubricating eye drops, and many are available without a prescription. Talk to your healthcare provider about which lubricating eye drops may be best for you.

Artificial Tears

Artificial tears help keep the eye surface moist. If you use drops often, ask your healthcare provider whether preservative-free drops are a better choice. Avoid redness-removing drops unless your eye doctor recommends them because they may worsen irritation.

Eye Gels and Ointments

Eye gels and ointments are thicker than regular drops, so they can last longer on the eye. They may be helpful at night if your eyelids don’t close fully.

Gels and ointments can make your vision blurry for some time after you put them in your eye. For this reason, these thicker formulations can be better for nighttime or when you don’t need to see clearly.

Selenium is a dietary mineral that the body needs in small amounts. A six-month course of selenium may be considered for mild active TED, especially in areas where people may not get enough selenium.

It’s not clear whether selenium provides the same benefits for people who already get enough selenium. Talk with your doctor before starting selenium because taking too much can be harmful and evidence does not support using it longer than six months.

Restoring normal thyroid function is an important part of TED treatment. When your thyroid is working properly, it helps regulate your metabolism (how your body turns food into energy).

TED is most commonly associated with Graves’ disease, a condition that often causes hyperthyroidism (high levels of thyroid hormones). Treatments for hyperthyroidism may include:

• Antithyroid drugs
• Radioactive iodine
• Thyroidectomy (removal of the thyroid gland)

Radioactive iodine can worsen TED. It’s generally avoided in people with active moderate to severe or sight-threatening TED.

TED is also associated with hypothyroidism (low levels of thyroid hormones). If you have hypothyroidism, treatment usually includes taking thyroid replacement medications.

Although restoring your normal thyroid function is an important part of your TED treatment plan, it’s important to know that treating thyroid problems probably won’t resolve TED symptoms.

Surgery may be an option when TED is inactive and stable. Surgery can help improve certain cosmetic concerns, as well as improve some symptoms.

Surgical options for TED include:

• Orbital decompression — Reduces eye bulging by removing extra fat or bone so the eye can be repositioned in the socket
• Eye muscle surgery — Improves double vision by tightening or loosening certain eye muscles
• Eyelid surgery — Helps you open and close your eyes more fully by repositioning the eyelids

If your disease is active, you may need urgent surgery for sight-threatening problems such as optic nerve compression or other complications.

Orbital radiotherapy uses targeted radiation to treat inflammation around the eye. It may be used for active moderate to severe TED when double vision is a problem. It’s often combined with corticosteroids.

Orbital radiotherapy isn’t right for everyone. It’s used cautiously in people with diabetes and is generally not recommended for people younger than 35.

If you have double vision, your healthcare provider may prescribe prism glasses. Prisms can help bring two images together into one clearer image.

Prisms don’t work for everyone. If they don’t help enough, an eye patch or eye muscle surgery may be an option.

Dark sunglasses may help with light sensitivity. They can also help protect your eyes from harmful ultraviolet rays.

There are several changes you can make in your daily habits that may help improve TED symptoms. These steps can help you feel better alongside other treatments.

Quitting Smoking

If you smoke, quitting is one of the most important steps you can take. Smoking increases the risk of TED and can make it harder to treat. Your healthcare provider can help you develop a plan for quitting.

Taping Your Eyelids

If your eyelids don’t completely close while you sleep, taping your eyelids may help prevent dry eyes. Make sure to use a gentle, hypoallergenic tape specifically designed for the skin to avoid irritation.

Elevating Your Head

Keeping your head higher than your body when you lie down can help relieve pressure on your eyes and reduce eyelid swelling. You can try propping up the head of your bed or using extra pillows.

Applying a Cool Compress

A cool compress may help soothe dry or irritated eyes. Use gentle pressure, and stop if it causes pain.

Clinical trials for TED are research studies that can help find new treatments. There are several ongoing clinical trials for new TED treatments. Talk to your healthcare provider to find out if you qualify for any clinical trials.