Eye Pain, Pressure, and Inflammation

Eye discomfort and pain is a common symptom of thyroid eye disease (TED). TED affects the tissues behind and around the eyes, causing pain and pressure. Depending on the severity and phase of the disease, you may experience different complications linked to TED.1

TED is an autoimmune disease, where the body’s immune system begins to mistakenly attack healthy tissues. In TED, the immune system attacks tissues behind and around the eye. The result is inflammation, which is your body’s response to the immune system attack. Inflammation leads to pain, pressure, and discomfort – all of which are common in TED.1

Dry eye and irritation

The clear layer of tissue that lines the front of your eye is known as the cornea. This tissue protects the eye and bends incoming light for normal vision. The cornea also sends pain signals to the brain through its many nerves.2

The tears on your eyes are a perfect mix of oil on water, held onto the surface of your eye by mucus. Blinking washes the tears over the cornea, smoothing its rough surface.

If you cannot properly blink or blink often enough, the surface of your eyes is not moisturized and replenished. This leads to a rough outer layer, like sandpaper. A rough outer eye surface can lead to injury and problems with vision.2

Corneal ulcer

An open sore on the cornea is called a corneal ulcer. Minor injury, wearing contact lenses too long, or something in your eye (foreign body) can lead to a corneal ulcer.3

If you have TED and the swelling makes it hard for you to close your eyes, you are at risk of developing a corneal ulcer. The protective and refreshing jobs of your eyelids and tears are affected by TED, increasing the risk of injury to the cornea.4

Symptoms of corneal ulcers include:3

  • Eye pain and redness
  • Too many tears or watery eyes
  • Blurred or reduced vision
  • Pain or sensitivity to light (photophobia)
  • Difficulty opening your eyelid
  • A gritty feeling or a feeling that something is in your eye

Swelling and pressure

Fat behind the eye acts as a cushion from the bony socket, where the eyeball sits. However, TED causes this fat to swell and can push the eye forward out of the socket. This leads to the classic stare-like glance and bulging eyes in TED. About 6 out of 10 people with TED experience protruding eyes, known as proptosis (prop-toe-sis) or exophthalmos (ek-sof-thal-muhs).4,5

The physical pushing of the eye out of the socket causes pressure and discomfort for many people with TED.

Eye movement pain

When TED impacts the muscles of your eyes, moving your eyes can become painful. TED causes inflammation and hardening (fibrosis) of the muscles that attach to the eye. These muscles, known as extraocular muscles, are responsible for the movement of your eyes.6

When these muscles are swollen and thickened, they do not work correctly and can lead to decreased eye movement. Additionally, the swelling of the muscles can cause pain when you move your eyes and might lead to vision problems like double or blurred vision.5

Treatment

As with most diseases, treatment for pain related to TED depends on its cause and severity. At-home remedies like ice or heat packs, rest, or pain killers may be options for some. For others, treatment will involve prescription drugs.7

Steroids, which are potent anti-inflammatories, might be needed when swelling is severe and causing pain. For longer-term treatment, others may need disease-modifying drugs to prevent the cause of the inflammation and immune system malfunction.7

Talk to your doctor or TED specialist about your symptoms. Treatment options are available to help you manage the pain, pressure, and inflammation that can occur with TED.

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Written by: Katie Murphy │Last Reviewed: October 2021