Thyroid Eye Disease Treatment Options

TED typically has an active phase which consists of inflammation and tissue expansion around the eyes, and it lasts about a year. For mild cases, supportive treatments to ensure lubrication of the ocular surface with use of artificial tears and gel is recommended. In the past, patients with significant inflammation in the active phase were treated with high dose systemic corticosteroids or orbital irradiation, but neither of these treatments are FDA approved for the treatment of TED, and they also have potential serious side effects. In the last couple years, a breakthrough FDA approved therapy, Tepezza, has emerged which specifically targets the tissue around the eye, attaching to receptors (IGF-1R) that are thought to potentiate the. This causes reduction of inflammation and eye bulging, and in many cases a return to normal facial appearance and function. As the chart demonstrates below, treatment of TED can reduce disease severity, and potentially obviate the need for surgery.

The stable phase of disease is when the disease stops progressing or inflammation subsides. The disease and facial changes do not return to normal, but they do not progress. In the past surgery was the only solution in the stable phase, but Tepezza has shown to reverse eye bulging, double vision and facial changes in patients who have had the disease for many years in the stable phase. As it is continues to be investigated in patients with chronic disease, it will likely emerge as a key tool in our toolbox for rehabilitation in patients with longstanding TED, in many cases obviating the need for surgery or allowing for smaller surgeries with reduced downtime. 

For patients who require or desire surgery, customized TED transformation surgery can be performed to maximize functional and aesthetic results. Typically, in customized surgery, both sides can be done in addition to eyelid and facial reshaping in one single surgery.  Typically, surgery lasts 2-3 hours and initial recovery is 2-3 weeks of bruising and swelling.