Thyroid eye disease assessment (Assessment of thyroid eye disease (Graves' orbitopathy))

A specialist eye and thyroid review for people with thyroid eye disease, to measure how active and severe it is, protect sight, and plan treatment.

✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review

In short

It measures how active and how severe the eye disease is, to guide treatment and protect sight.
Treating your thyroid levels helps overall, but does not by itself cure the eye disease, which often follows its own course.
Stopping smoking is one of the most important steps, as smoking worsens TED and reduces how well treatment works.
Some sight-threatening features are an emergency; sudden change in vision or colour vision needs urgent specialist care.

A plain-English summary. The detail — including risks and recovery — is below.

At a glance

TypeSpecialist clinical assessment (eye and thyroid)

AnaestheticNot needed

How long it takesOne or more clinic appointments, sometimes with a scan

Hospital stayOutpatient

Time off workUsually none, beyond time for appointments

When you'll see resultsAn initial picture at the appointment; activity and severity are tracked over time

On the NHS?Commonly assessed on the NHS; private care is mainly used for speed or choice

A general guide. Your specialist will give you advice for your situation.

Best fit

Measures how active and severe the disease is to guide treatment

Pause if

Treating the eye disease as cured simply by controlling the thyroid, without a proper eye assessment.

Main recovery point

You learn how active and severe your disease is and whether your sight is at risk, and agree initial steps such as eye-surface care and stopping smoking.

Good aftercare

A clear statement of how active and severe the disease is, with a monitoring plan.

At the appointment

You learn how active and severe your disease is and whether your sight is at risk, and agree initial steps such as...

Soon after

Any scan or further tests are completed, and thyroid control is optimised with your endocrine team.

During the active phase (often months to ~2 years)

You are monitored, and anti-inflammatory treatment may be considered if the disease is active and severe enough.

Once inactive

If problems such as bulging, eyelid position or double vision remain, surgery may be discussed in a planned...

Medical line illustration of thyroid and neck endocrine anatomy for Thyroid eye disease assessment. — Illustration only - not a diagnosis, medical advice or a promise of result. Your anatomy and treatment plan may differ. Vuemedics does not publish before-and-after photos.

What is a thyroid eye disease assessment?

Thyroid eye disease (TED), also called Graves' orbitopathy, is an autoimmune condition that affects the muscles and soft tissues around the eyes. It is most often linked to an overactive thyroid from Graves' disease, but it can occur with other thyroid states too.

An assessment measures two things: how active the disease is (how much inflammation there is now) and how severe it is (how much it is affecting the eyes and sight). This matters because active disease may respond to treatment, while inactive 'burnt-out' disease is managed differently.

The assessment also checks for sight-threatening features, such as pressure on the optic nerve, which are uncommon but important to catch early. It looks at eye movement, double vision, the position and bulging of the eyes, and the surface of the eye.

Controlling your thyroid levels is part of overall care, but treating the thyroid does not by itself cure the eye disease. Stopping smoking is one of the most important things you can do, because smoking makes TED worse and treatment less effective.

Types, options & approaches

There may be different ways to do this. The right approach depends on the clinical question and your circumstances.

Clinical eye examination

Checking eye movements, double vision, eyelid position, how far the eyes bulge (proptosis), and the surface of the eye for dryness or exposure.

Activity scoring

Using a clinical activity score to judge how much active inflammation there is, which helps decide whether anti-inflammatory treatment may help.

Sight checks

Testing vision, colour vision and side vision to look for early signs of pressure on the optic nerve, which is sight-threatening and needs urgent care.

Thyroid blood tests

Checking thyroid hormone levels and thyroid antibodies, as good thyroid control is part of overall management.

Imaging

A CT or MRI scan of the eye sockets may be used to assess the muscles and soft tissues, especially before treatment or surgery.

Active versus inactive thyroid eye disease

Phase	What is happening	How it is managed
Active phase	Inflammation, often with redness, swelling and change	May respond to anti-inflammatory treatment; protect the eye surface
Inactive phase	Inflammation settled; any changes are 'burnt out'	Surgery may help fixed problems like bulging or double vision
Sight-threatening	Pressure on the optic nerve or severe exposure	Urgent specialist treatment to protect vision

The active phase often lasts months to a couple of years. Knowing the phase guides whether to treat inflammation now or wait.

Preparing for your treatment

Bring details of your thyroid condition, recent thyroid blood tests and any thyroid treatment, including radioactive iodine.
List your eye symptoms and when they started, such as grittiness, watering, redness, bulging, double vision or pain.
If you smoke, know that stopping is strongly advised, and ask for help to quit.
Note any change in vision or colour vision, which needs to be flagged straight away.
Bring your glasses and any previous eye records or photographs of your eyes over time.
Mention all medicines, including steroids, and any other autoimmune conditions.
Write down how the symptoms affect daily life, such as driving or screen use.

What happens

A specialist, often an eye doctor (ophthalmologist) working with your endocrine team, asks about your symptoms and thyroid history and examines your eyes in detail.

They check how the eyes move, whether you have double vision, the position and bulging of the eyes, eyelid swelling and retraction, and the surface of the eye. They test your vision, colour vision and side vision to look for any pressure on the optic nerve.

A clinical activity score helps judge how much active inflammation there is. Thyroid blood tests are reviewed, and a CT or MRI scan of the eye sockets may be arranged.

The specialist then explains how active and severe your disease is, whether your sight is at risk, and what the options are, from eye-surface care and stopping smoking through to anti-inflammatory treatment or, later, surgery for fixed problems.

Is this treatment right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

May not be suitable if…

Treating the eye disease as cured simply by controlling the thyroid, without a proper eye assessment.
Planning cosmetic-type eye surgery while the disease is still active and changing.
Ignoring sight-threatening symptoms, which need urgent care rather than a routine assessment.
Using the assessment as a substitute for stopping smoking and controlling the thyroid, which strongly affect outcome.

Delay or rearrange if…

Your thyroid levels are very unstable and need stabilising first as part of overall care.
You have sudden visual symptoms that need urgent treatment rather than routine review.
Surgery for fixed problems is being considered but the disease is still active.
You are about to have radioactive iodine and the eye risk has not yet been discussed.

Alternatives to discuss

Supportive measures alone, such as lubricating drops, sunglasses and head elevation, in mild disease.
Optimising thyroid control and stopping smoking as first steps.
Anti-inflammatory treatment during the active phase where indicated.
Surgery once the disease is inactive for fixed problems such as bulging, double vision or eyelid position.
A different thyroid treatment if radioactive iodine poses too much risk to the eyes.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

What matters most to me?

Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.

What are all my options?

Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.

What would make me pause?

Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.

What happens if I do nothing today?

For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.

Benefits

Measures how active and severe the disease is to guide treatment
Checks for sight-threatening features so they can be treated early
Helps protect the surface of the eye from drying and exposure
Links eye care with good thyroid control
Provides clear advice on smoking and other steps that affect the disease
Sets realistic expectations about the disease course and what surgery can and cannot fix

Risks & complications

More common

Discomfort from bright lights or eye examination
Needing more than one appointment to track how the disease changes
Uncertainty, as it can be hard to predict how the disease will behave
Finding that treatment must wait until the active phase settles

Less common

Anxiety about changes in appearance or vision
A scan showing changes that need further specialist input
Symptoms worsening during the active phase despite care

Rare but serious

Discovering sight-threatening optic nerve involvement that needs urgent treatment

The biggest concern is missing sight-threatening disease, so any sudden change in vision, colour vision or new severe eye pain must be acted on urgently. The other key points are that treating your thyroid does not cure the eye disease, and that smoking makes TED worse. Ask how active and severe your disease is, whether your sight is at risk, and what your monitoring plan is.

Published figures to discuss

How thyroid eye disease behaves varies a lot between people. Many cases are mild and settle, while a minority become moderate-to-severe or sight-threatening. Smoking, poor thyroid control and, in some people, radioactive iodine can make it worse. Because the course is so individual, this guide describes the phases and warning signs rather than quoting precise percentages.

Figure	Reported range	How to interpret it	Source / confidence
Mild disease course	Common; many cases are mild and settle over time	Lubricants, selenium in selected mild active disease, smoking cessation and stable thyroid control are still important.	Guide sourcesClinical context
Sight-threatening thyroid eye disease	Minority, but urgent	Reduced colour vision, dim vision, corneal exposure, severe pain or rapidly worsening swelling needs urgent ophthalmology review.	Guide sourcesClinical context
Smoking effect	Major modifiable risk factor	Smoking increases risk and severity and reduces treatment response; cessation advice is core treatment.	Iodine contrast should be avoided in patients with thyroid eye disease — PMCncbi.nlm.nih.govSource-linked context
Steroid, radiotherapy or surgery harms	Treatment-specific	Moderate-to-severe disease needs specialist discussion of IV steroids, radiotherapy, decompression, squint or eyelid surgery risks.	Iodine contrast should be avoided in patients with thyroid eye disease — PMCncbi.nlm.nih.govSource-linked context

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

What happens afterwards

There is no physical recovery from the assessment itself; afterwards you have a clearer picture of your disease and a plan, with monitoring as the disease evolves.

At the appointment

You learn how active and severe your disease is and whether your sight is at risk, and agree initial steps such as eye-surface care and stopping smoking.

Soon after

Any scan or further tests are completed, and thyroid control is optimised with your endocrine team.

During the active phase (often months to ~2 years)

You are monitored, and anti-inflammatory treatment may be considered if the disease is active and severe enough.

Once inactive

If problems such as bulging, eyelid position or double vision remain, surgery may be discussed in a planned sequence.

Ongoing

Regular review continues, with urgent access if vision changes.

What's normal — and not a worry

Gritty, watery or light-sensitive eyes that need lubricating drops
Symptoms fluctuating during the active phase
Being asked to attend several reviews to track activity
Waiting for the active phase to settle before surgery
Needing ongoing thyroid blood tests

Aftercare

Use lubricating eye drops or ointment as advised to protect the eye surface.
Stop smoking and seek support to do so, as this strongly affects the disease and treatment.
Keep your thyroid levels well controlled with your endocrine team.
Attend monitoring appointments so changes in activity or sight are picked up.
Raise the head of the bed and use advised measures if swelling is troublesome.
Report any change in vision, colour vision, new double vision or severe eye pain urgently.
Tell your team if you are due radioactive iodine, as eye disease may influence the plan.

Before your treatment

Lubricating eye drops or ointment obtained
Stop-smoking support arranged if you smoke
Recent thyroid blood tests and treatment details to hand
A note of your eye symptoms and any changes
Sunglasses for light sensitivity
Urgent contact route saved for vision changes
Follow-up appointment booked

⚠ Get urgent help if…

Any sudden change in vision, blurring or loss of vision — seek urgent eye care
Colours, especially red, looking faded or washed out — this can signal optic nerve pressure
New or rapidly worsening double vision
Severe eye pain, or pain when moving the eyes
Marked, rapid bulging of an eye or an eye that cannot close fully, with a red, sore surface
Light flashes, a curtain across the vision or other warning signs of an eye emergency

Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your specialist gives you.

Results & realistic expectations

A useful assessment tells you how active your disease is now, how severe it is, and whether your sight is at risk. Active disease may respond to anti-inflammatory treatment, while fixed changes in the inactive phase may be helped by surgery once things have settled.

The assessment cannot promise how the disease will behave or that appearance will return exactly to how it was before. Good thyroid control and stopping smoking improve the outlook, but the eye disease often runs its own course over months to a couple of years. The aim is to protect sight, ease symptoms and plan treatment at the right time.

How long it lasts

Thyroid eye disease typically has an active phase lasting months to around two years, followed by an inactive phase. Even after it settles, some changes can remain, and a small number of people have a flare later. Regular review helps catch changes early, and any surgery is usually planned once the disease is stable.

Related tests, treatments or support

Thyroid eye disease care is closely linked with managing your thyroid condition and, where relevant, with decisions about radioactive iodine, which can sometimes worsen the eyes, especially in smokers. If surgery is needed, procedures to relieve pressure, correct double vision and adjust the eyelids are usually done in a planned order once the disease is inactive.

Follow-up & long-term care

You will usually be reviewed regularly while the disease is active, with thyroid blood tests and eye checks, and with urgent access if your vision changes. Once the disease is inactive, follow-up focuses on any remaining problems and whether surgery would help.

Lubricating eye drops to keep the eye surface comfortable
Stopping smoking and staying smoke-free
Ongoing good control of thyroid levels
Regular eye reviews while the disease is active
Urgent review for any change in vision

Repeat, follow-on and what comes next

The disease is reassessed over time, because activity and severity change.
Treatment during the active phase may need adjusting depending on response.
Surgery for fixed changes is often done in stages once the disease is stable.
A small number of people have a later flare needing further assessment.

Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.

What good aftercare looks like

A clear statement of how active and severe the disease is, with a monitoring plan.
Eye-surface care advice and strong support to stop smoking.
Joint working between eye and thyroid specialists to control the thyroid.
An urgent contact route and clear instructions for any change in vision.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

The specialist (ophthalmologist and endocrinologist) fees
How many monitoring appointments are needed while the disease is active
Imaging such as a CT or MRI scan of the eye sockets
Thyroid blood tests and antibody tests
Any anti-inflammatory treatment, which may need a hospital setting
Later surgery for fixed changes, if needed

Make sure your written quote includes

The specialist fees and how many follow-up appointments are included
Whether imaging is included or charged separately
Which blood tests are covered
What treatment would cost if the disease is active and needs anti-inflammatory therapy
What planned surgery would involve and cost if changes remain
An urgent contact route for any change in vision

On the NHS? Thyroid eye disease is commonly assessed on the NHS, often in a joint eye and thyroid clinic; private care is mainly used for speed or choice of specialist.

You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.

Choosing a specialist safely

Check the specialist is on the GMC Specialist Register for this area.
Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
You're entitled to your total cost in writing — including any follow-up — before you decide.

How Vuemedics verifies every consultant →

Questions to ask your medical professional

Take this to your consultation. A good specialist will welcome every one of these.

How active and how severe is my thyroid eye disease right now?
Is my sight at risk, and what symptoms should make me seek urgent help?
What can I do, including stopping smoking, to improve the outlook?
Should I have treatment now, or wait for the active phase to settle?
How does my thyroid treatment, including any radioactive iodine, affect my eyes?
If changes remain, what could surgery realistically fix and when?
Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
Will you be the specialist who carries out my treatment, and who looks after me afterwards?
What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
What does a realistic result look like — and what can this treatment not achieve?
What are my options, including waiting, doing nothing for now, or choosing a different approach?
Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Frequently asked questions

If my thyroid is treated, will my eyes go back to normal?

Good thyroid control helps overall, but treating the thyroid does not by itself cure the eye disease. TED often runs its own course, and the eyes are assessed and managed separately.

Why does smoking matter so much?

Smoking makes thyroid eye disease worse and makes treatment less effective. Stopping smoking is one of the most important things you can do for your eyes.

Is thyroid eye disease an emergency?

Usually not, but some features are sight-threatening. Any sudden change in vision, faded colours, severe eye pain or rapidly worsening double vision needs urgent specialist care.

Can radioactive iodine affect my eyes?

It can sometimes trigger or worsen thyroid eye disease, particularly in smokers. Tell your team about any eye symptoms before treatment so they can plan accordingly.

When can I have surgery for bulging eyes or double vision?

Surgery for fixed changes is usually planned once the disease is inactive and stable, often in a set order. Your specialist will advise on timing.

Is the assessment available on the NHS?

Yes, thyroid eye disease is commonly assessed on the NHS, often in a joint eye and thyroid clinic. Private care is mainly used for speed or choice of specialist.

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How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: TEDct — Understanding the stages of thyroid eye disease (patient guide) British Thyroid Foundation — Thyroid eye disease (TED) TEDct — Thyroid eye disease frequently asked questions Iodine contrast should be avoided in patients with thyroid eye disease — PMC Royal College of Ophthalmologists Thyroid eye disease — British Thyroid Foundation patient leaflet Management of Graves’ orbitopathy: initial assessment and referral — PMC Endocrine Society — thyroid eye disease patient information NICE NG145 — Thyroid disease: assessment and management (2019)

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.