Update on Graves Disease

Advances in Treatment of Mild, Moderate and Severe Thyroid Eye Disease

Diego Strianese


Curr Opin Ophthalmol. 2017;28(5):505-513. 

In This Article

Inactive Disease

Surgical rehabilitation of inactive TED requires a clear understanding of the desired and achievable outcomes between the patient and the surgeon. It is important to address proptosis, strabismus and lid retraction in this order, if all are present, as the effect of the preceding operation may influence the subsequent one. Most patients will not require the full series of operations, but patients should be informed that the rehabilitative journey may take 1–2 years.

The advocated customized surgical approach for the TED patient requires accurate evaluation of the proptosis,[47] orbital soft changes, and particularly a quantitative evaluation of the proportion of muscle and/or fat volume as well as of the orbital bone shape which can be modified by the disease.[48–50]

Correction of vertical diplopia may be addressed with the use of adjustable sutures, possibly underestimating the amount of correction in order to avoid late overcorrection. This requires careful preoperative counselling of the patient in order to explain that immediate undercorrection and persistent diplopia are necessary to obtain a favorable long-term result[52]