Thyroid Eye Disease

Thyroid eye disease (TED) is an autoimmune inflammatory disorder that affects the tissue in and around the eye socket, also known as the orbit.  It is most common in patients with Graves’ disease, affecting 20 to 50% of patients.  It can also be associated with Hashimoto’s thyroiditis and patients with normal thyroid function (euthyroid).

The autoimmune reaction leads to inflammation and enlargement of the fat and muscles in the orbit.  This leads to swelling around the eyes, eyelid retraction, bulging eyes (proptosis), double vision (diplopia), and elevated intraocular pressure.  In more severe cases, proptosis can lead to exposure and breakdown of the cornea (keratopathy).  Enlargement of the orbital contents can result in compressive optic neuropathy, leading to irreversible vision loss.

TED can significantly impact a person’s quality of life due to its adverse effects on the eyes, as well as the physical changes it causes to one’s appearance.  Management can range from simple supportive therapy for mild cases, such as eye lubrication with artificial tears, to immunosuppressive therapy and surgical intervention for more severe or vision-threatening cases.

Tepezza was FDA-approved in January 2020 specifically for the treatment of TED.  It is administered via 8 intravenous infusions over a 24-week period.  It has been shown to reduce proptosis by 2 mm and can decrease eyelid swelling and diplopia.  All patients at Atlantic Eye are closely followed with coordinated care involving endocrinology and otolaryngology.  Below is a case of one of our patients who was successfully treated with Tepezza.

Brian R. Hall, OD, FAAO
Ocular and Neuro-ophthalmic Disease
Atlantic Eye