Advances in the Management of Thyroid Eye Disease

César A. Briceño, MD; Shivani Gupta, MD, MPH; Raymond S. Douglas, MD, PhD


Int Ophthalmol Clin. 2013;53(3):93-101. 

In This Article


Thyroid Eye Disease (TED)

TED is a term used to describe a combination of adnexal and orbital findings that occurs most commonly in autoimmune thyroid disease. Typical findings in TED include proptosis, upper eyelid retraction with temporal flare, conjunctival injection, chemosis, and periorbital edema (Fig. 1). The clinical manifestations of TED often lead to morphologic facial changes that are disfiguring and may lead to reduced quality of life. In addition, potential sight-threatening morbidities of TED include exposure keratopathy, optic nerve compression, and diplopia. Primary risk factors for TED not only include environmental influences, especially smoking, but also prior pathogen exposures, stress, and previous use of radioiodine in addition to a complex genetic component.[1] TED more commonly affects women compared with men, with a ratio of approximately 5:1.[2]

Figure 1.

A, Typical clinical appearance of a patient with TED, demonstrating lid retraction, proptosis, conjunctival injection, and chemosis. B, Details demonstrating marked conjunctival injection over the insertion of the medial rectus and caruncular edema in the same patient.

TED is a self-limited condition that manifests in 2 phases. The initial phase or active phase is characterized by a fluctuating inflammatory course over months to years that eventually transitions into a nonprogressive phase. Typically, after the resolution of the active phase, there may be a mild but incomplete improvement of the associated signs. Unfortunately, no treatments are available at this time to prevent the disease progression and subsequent permanent facial disfigurement. The mainstay of therapy during the active phase is observation. Systemic corticosteroids may provide symptomatic improvement but may seldom halt the disease progression. Corticosteroids are also associated with a variety of well-known adverse effects, which may limit the treatment. Once the disease reaches a nonprogressive phase, the mainstay of treatment remains surgical. Surgical rehabilitation is staged to include orbital decompression, strabismus surgery, and eyelid surgery, to improve the disease appearance and function.