“My eyes are twitching and dry. I was wondering if there is anything that I can do,” a TEDhealthteam member commented. Thyroid eye disease (TED) can cause uncomfortable symptoms in the eyes, a topic frequently discussed by TEDhealthteam members.

Eye drops are essential for relieving dryness and irritation and for protecting the surface of the eye, including the cornea and conjunctiva, from damage caused by TED. The condition is also known as Graves’ eye disease, Graves’ ophthalmopathy, and Graves’ orbitopathy. TED is caused by the autoimmune condition, Graves’ disease, which causes the thyroid to overproduce thyroid hormones, a condition known as hyperthyroidism.

In people with TED, the immune system attacks the muscles that control eye movement as well as other tissues that surround the eyes. This attack causes inflammation during the active phase of the disease, resulting in symptoms such as proptosis (bulging eyes), swelling around the eyes and eyelids, eye pain, light sensitivity, and dry, irritated eyes. In more severe cases, it can lead to double vision, damage to the optic nerve, and vision loss.

If you have TED, be sure you’re following your treatment plan for Graves’ disease, along with treatment recommendations for TED. Report any new or worsening symptoms to your ophthalmologist or endocrinologist, who can give you medical advice on how best to treat your eyes. Over-the-counter (OTC) eye drops are used to treat mild cases of TED. Other treatments may be recommended, depending on the severity of your symptoms.

When choosing OTC eye drops, it’s important to know which ones are best for people with TED. Here’s what to look for.

There Are Two Main Types of Lubricating Eye Drops

OTC lubricating eye drops — also known as artificial tears — are typically recommended for people with mild TED. The two most common types of lubricating eye drops are eye drops for evaporative dry eye and eye drops for aqueous-deficient dry eye.

People with TED can have characteristics of both evaporative dry eye and aqueous-deficient dry eye.

If you have evaporative dry eye, your tears evaporate more quickly than normal. Eye drops for evaporative dry eyes have oil-based ingredients that help hold moisture. This type of eye drop will list oil in the ingredients. The packaging may also mention evaporative dry eye.

If you have aqueous-deficient dry eye, your eyes don’t produce enough tears. Packaging for eye drops for aqueous-deficient dry eye will mention “hypoosmolar” or “hypotonic.” This type of eye drop is thinner than eye drops with oil and will help increase the wetness and amount of tears in your eyes.

According to the American Academy of Ophthalmology, either type of eye drop can treat dryness caused by a variety of eye conditions, including those caused by autoimmune diseases such as TED. Your eye doctor can advise you on which type of eye drop may be better for you.

Preservative-Free Eye Drops Are Better for TED

Many eye drops have preservatives, which are chemicals that help prevent bacteria from developing. Preservatives can also give eye drops a longer shelf life. However, eye drops with preservatives are not recommended for people who use eye drops more than four times a day. People with TED sometimes use eye drops as often as every 30 to 60 minutes per day to keep their eyes moisturized and comfortable.

One common preservative in eye drops is benzalkonium chloride, which has been linked to increased dry eye and other complications that can damage eyes.

Look for preservative-free lubricating eye drops to avoid added chemicals that may not be good for your eyes.

Using Gel-Based Eye Drops

Thicker, gel-based eye drops are often recommended for use at night to treat dryness and irritation from TED. Thicker gel eye drops help keep your eyes moist for a longer time, but they can also make your vision temporarily blurry. For that reason, they’re a better choice to use before bedtime.

You Should Avoid Eye Drops for Red Eye Relief

Some eye drops are designed to relieve redness in eyes, sometimes called whitening drops. But they are generally not recommended for people with TED, even if your eyes are red from irritation. Eye drops for redness relief often contain the decongestant tetrahydrozoline, which reduces swelling in blood vessels in the eyes and temporarily can decrease redness or pinkness. However, when this effect wears off, redness can return and worsen, known as a rebound effect.

Another decongestant found in some eye drops used to treat redness is called brimonidine. Although brimonidine works somewhat differently than tetrahydrozoline and has less risk for redness rebound, there has been concern that ophthalmology studies on brimonidine have not considered long-term effects.

Eye drops designed to relieve redness do not address dryness, which is a crucial issue to treat for individuals with TED. Always read the packaging information on eye drops. Some lubricating eye drops may also be labeled as “reducing red eyes” and should be avoided.

Some Eye Drops Have Been Recalled Due to Infection Risk

In recent years, some eye drops have been recalled because they increased the risk of infection. Although unlikely, some of these eye drops may still be for sale. The FDA has a list of recalled eye drops that should be avoided. It’s a good idea to always ask your doctor for advice before trying a new eye drop.

It’s Best To Maintain Your Eye Treatment Plan

If you have active TED, sticking to your daily treatment plan, as recommended by your doctor, is the best way to protect your eye health and feel your best. Don’t make changes to your TED treatment plan without talking to your doctor. If you’re not happy with your treatment and your TED is affecting your quality of life, discuss other treatment options with your ophthalmologist or endocrinologist.

Along with eye drops, your doctor may recommend a treatment plan that includes:

• Applying an eye ointment at night

• Taping your eyelids at night

• Keeping your head elevated when resting or sleeping

• Using cool compresses to help reduce dry eye and swelling

• Making lifestyle changes such as quitting smoking, which can aggravate TED

• Using a humidifier in your home or workplace

If eye drops alone do not effectively control your TED symptoms, and they are worsening or your condition has progressed to moderate or severe TED, your doctor may recommend other treatments such as:

• Teprotumumab-trbw (Tepezza) or another biologic drug

• Corticosteroids (steroids)

• Immunosuppressants such as mycophenolate mofetil (CellCept)

• Selenium supplements

• Eyeglasses

• Orbital radiotherapy, a type of radiation treatment for the eyes

• Orbital decompression surgery (to reduce bulging), eye muscle surgery, or eyelid surgery

• Changing your thyroid treatment

Open communication and regular follow-up with your doctor about your symptoms of TED can help ensure that you are getting the best treatment possible. Be sure to tell your doctor about any new symptoms or changes in your condition. Regular check-ins with your doctor allow for adjustments to your treatment plan, ensuring it remains effective.

Talk to Others Who Understand

TEDhealthteam is the social network for people with thyroid eye disease and their loved ones. On TEDhealthteam, members come together to ask questions, give advice, and share their stories with others who understand life with TED.

Have you talked to your doctor about eye drops for TED? Which eye drops work best for you? Share your experience in the comments below, or start a conversation by posting on your Activities page.