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Treatment for Thyroid eye disease

Treatment for thyroid eye disease (TED) is multi-pronged and the timing of treatment is important.

The initial inflammatory phase of the disease can stretch from 18 to 36 months and is then followed by a quiescent (inactivity or dormancy) phase. The treatment during the initial phase is aimed at protecting the vision and the state of the cornea, as well as limiting the amount of permanent damage caused by the inflammatory phase. The 2nd phase of the disease is where correction of permanent changes due to TED can be performed.

  • Achieving a euthyroid status (the state of having normal thyroid gland function) with the help of an Endocrinologist and smoking cessation are necessary to help reduce the risks of exacerbation of TED and reduce the duration of the activity of inflammation.
  • To directly control the inflammatory activity of TED, the first-line treatment would be to start intravenous steroids. This may be needed over a course of 6 to 12 weeks depending on the response to treatment, as well as the tolerability of the individual, due to considerable side effects which can develop.
  • Lubricating eyedrops and ointments.
  • Some immunosuppressant may help to control the disease. However, these may carry a risk of unwanted effects of immune-depression.
  • Orbital radiation is sometimes given concurrently with steroid therapy to reduce orbital inflammatory activity. However, it can exacerbate dry eye.
  • Orbital decompression surgery may be required in a select group of individuals as an elective procedure when the TED condition has stabilised. However, it is sometimes required to be done as a semi-urgent procedure in cases where TED-associated compressive optic neuropathy occurs. Read more about Orbital Decompression Surgery.
  • Strabismus (eye muscle) surgery to correct double vision.
  • Eyelid retraction repair to achieve better closure of the eye while blinking and eyelid symmetry.