TED Flare‑Ups Cold & Flu Season Eye Symptoms: Why They Happen — Immune System Connection

Have you ever noticed your eyes feeling more irritated, swollen, or dry when you catch a cold or the flu — even though your primary eye condition is Thyroid Eye Disease (TED)? It may not be just a coincidence. As someone living with an autoimmune eye condition (or caring for someone who does), understanding how seasonal illnesses can trigger or worsen flares can help you anticipate, manage, and prevent unpleasant surprises.

Thyroid Eye Disease flare-ups can occur during cold or flu seasons due to immune system reactions, leading to eye irritation and worsening symptoms.

What is Thyroid Eye Disease (TED), and Why It Fluctuates: Cold & Flu Season Eye Symptoms

Thyroid Eye Disease — sometimes called Graves’ orbitopathy — is an autoimmune condition in which your immune system mistakenly attacks the tissues behind and around your eyes. This attack inflames the fat, muscles, connective tissues, and blood vessels in the eye socket, leading to swelling, bulging eyes, eyelid changes, and often irritation, dryness, or grittiness at the ocular surface. Yale Medicine+2NCBI+2

Traditionally, TED has been described as having an “active” (inflammatory) phase and a “chronic” (fibrotic or inactive) phase. During the active phase, patients are more likely to notice swelling, redness, eye‑movement problems, and surface symptoms like dryness or excessive tearing. thyroideyes.com+1 .

However, newer understanding suggests TED may be more dynamic: flares or reactivation of symptoms can occur even after the initial phase seems to have settled, depending on external triggers and immune stimuli. thyroideyes.com+1

So why do cold or flu seasons seem to coincide with TED flares for some patients?

How Infections and Immune Activation Can Trigger Eye Surface Distress

When you catch a viral illness — like a cold or flu — your immune system springs into action. That’s a good thing: it's fighting off an intruder. But for someone with TED (or any immune‑mediated eye condition), this surge in immune activity can have unintended side effects of cold & flu season eye symptoms.

Research shows that viral infections can inflame the ocular surface and disrupt normal tear secretion from the lacrimal glands. PMC In some cases, infections can depress tear production and impair the stability of the tear film, leading to symptoms like dryness, burning, irritation, or gritty sensation — things many TED patients already struggle with.

Beyond tear production, immune activation affects the entire ocular environment. Inflammatory cells and cytokines can be drawn into the orbit and ocular surface.

In diseases involving chronic inflammation — such as autoimmune or systemic conditions — that inflammation can target not just the tissues behind the eye (muscles, fat, connective tissue) but also the glands and cells responsible for maintaining a healthy tear film. PMC+2Modern Optometry+2

In other words: a “simple” cold may destabilize your tear film, inflame surface tissues, and exacerbate dryness or irritation — especially in the context of TED, where everything is already more vulnerable.

Why Some People With TED May Feel Worse During Cold or Flu Season

For patients with TED, several overlapping factors may increase the risk of a flare during a systemic illness or seasonal infection:

• Immune system activation leading to inflammatory “spillover” into ocular tissues — not only the orbit but also the ocular surface and tear‑producing glands.

• Disruption of tear film homeostasis: reduced tear production or unstable tear composition can worsen sensations of dryness, irritation, and discomfort. Mayo Clinic+1

• Compounded stress on the ocular surface from environmental factors common in colder weather or indoor heating (less humidity, dryer air), which research shows can trigger or worsen symptoms of dry eye and ocular surface disease. Frontiers+1

• A possible “re‑activation” of autoimmune inflammation — even if your thyroid levels and orbit inflammation are stable — because your immune system is already “on alert.” tepezza.com+2thyroideyes.com+2

  
  

In short: seasonal illness can unbalance the delicate tear film, increase inflammation, and push the orbit/ocular surface from stable into symptomatic again — making a so-called “flare.”

What You Can Do to Protect Your Eyes During Cold or Flu Seasons

If you have TED (or a related ocular autoimmune condition), there are practical steps you can take when cold or flu season approaches:

First, pay extra attention to your tear film. Use preservative‑free artificial tears (as recommended by your ophthalmologist) to maintain lubrication, especially if you’re already feeling increased dryness or grittiness. Make sure to blink fully — and often, particularly if you’re indoors with dry air.

Humidify your indoor environment. Use a humidifier at home (especially if heating or dry air is common), or consider keeping a bowl of water near heat sources to add moisture to the air. Balanced humidity helps preserve tear film stability and reduces evaporative stress on the ocular surface.

During illness, protect your eyes from additional stressors: avoid rubbing your eyes, shield them from harsh environmental irritants (wind, strong air conditioning, smoke), and ensure adequate rest and hydration. Both systemic hydration and stable metabolic status support tear production.

If symptoms worsen — increased redness, pain, sudden change in vision, or persistent dryness despite lubrication — reach out to your ophthalmologist. A flare of surface inflammation may need prompt evaluation or temporary adjustment of your treatment plan, especially if the underlying autoimmune process is re‑activated.

Finally, communicate with your healthcare provider about any systemic illness, changes in thyroid status, or use of new medications or supplements — as these may influence your ocular health and TED stability.

The Big Picture: Eyes, Immunity, and You

Your eyes — especially when affected by a complex autoimmune condition like TED — don’t exist in isolation. They’re deeply connected to your whole-body immune system, your environment, and how well your body copes with stressors like infection. Recognizing that a cold or flu might not just be a “headache and sniffles” — but also a potential trigger for eye surface flares — empowers you to act early and protect your vision and comfort.

By staying vigilant, caring for your tear film, and watching for early signs of ocular surface stress, you significantly reduce the chance of discomfort or complication during cold/flu season.

If you want to learn more about managing TED and ocular surface health — or have concerns during a flare — we’re here to help.

Connect with Us

Website: www.southbayretina.com

Phone: (408) 294-3534

Serving: San Jose, Cupertino, and the greater South Bay Area

YouTube: youtube.com/@NarainEye

Instagram: @south_bay_retina

Facebook: @narain1

TikTok: @southbayretina

Podbean: southbayretinamedia.podbean.com

References

1. Wu, M., et al. (2023). Dry eye disease caused by viral infection. PMC. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC10761022/ PMC StatPearls. (2023). Thyroid Eye Disease. In NCBI Bookshelf. NCBI Yale Medicine. (2024). Thyroid Eye

   
   

2. Disease (TED). Retrieved from https://www.yalemedicine.org/conditions/thyroid-eye-disease-ted Yale Medicine Modernod. (2024). The role of inflammation and immune response in dry eye. Modern Optometry Frontiers in Toxicology. (2023).

   
   

3. The environment and dry eye — manifestations, mechanisms, and more. Frontiers Mayo Clinic Staff. (2022). Dry eyes — Symptoms & causes. Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/dry-eyes/symptoms-causes/syc-20371863 Mayo Clinic

WATCH THE FULL EPISODE'S HERE:

LISTEN TO THE PODCAST EPISODES: