Medical and surgical treatment of thyroid eye disease

Abstract

Thyroid eye disease is an autoimmune inflammatory disease strongly associated with thyroid disease, principally Graves disease. It can range from mild disease requiring observation or symptomatic treatments only, through to sight‐threatening disease requiring major drug therapy and orbital surgery. Severity is graded by the NOSPECS system and activity by the clinical activity score (CAS) to assist in treatment selection. Non‐surgical management can extend from observation alone to minor therapy such as oral selenium, then glucocorticoid therapy, cyclosporin, mycophenolate, rituximab, immunoglobulin, teprotumumab, and orbital radiotherapy. High‐dose intravenous methylprednisolone therapy is used in active vision‐threatening disease with early use of tarsorrhaphy and orbital decompression. Inactive but moderate to severe disease may be treated by orbital decompression, strabismus and eyelid surgery. Systematic assessment and management by both an endocrinologist and ophthalmologist to achieve and maintain euthyroidism and select and sequence treatments according to activity and severity of thyroid eye disease gives the best results for quality of life and vision.

Management of thyroid eye disease: a Consensus Statement by the American Thyroid Association and the European Thyroid Association

“…2a and b), strabismus, or lid malposition (Supplementary Fig. 2g,h and i,j) is typically delayed until the quiescent phase ( 55 , 56 , 57 ), although urgent surgery may be necessary during the active/progressive phase for DON, severe corneal exposure, or globe subluxation. Systemic medical and surgical treatment for TED are discussed in Sections 6–8.…”

Pillar tarsoconjunctival flap: An alternative approach for the management of refractory corneal ulcer

“…Tarsorrhaphy involves suturing of upper and lower eyelids in order to protect the cornea and the ocular surface and to preserve the trophism and homeostasis. [4][5][6][7][8] Both temporal and permanent tarsorrhaphies have been widely used for decades with good outcomes, but this technique has potential complications that might be difficult to treat, these include trichiasis (18%), adhesions between the upper and lower eyelids (2,6%), pyogenic granuloma (1,3%) and keloid scarring (1,3%) among others; 21 even in the absent of complications, tarsorrhaphy causes a blinking impairment, diminishes the visual field, and has a significant cosmetic impact for the patients.…”

“…Among these mentioned indications for the PTCF, this study includes the epithelial defects associated with NCU, PED and CM. PTCF is considered in those cases in which the epithelial defect does not respond to medical theraphy 4,7,8 and/or AMT. It is hypothesized that PTCF can promote corneal healing in at least two ways: through constant lubrication and through growth factors and other autologous molecules essential for ocular homeostasis.…”

“…This closure protects the cornea and ocular surface from environmental aggressions, prevents epithelial damage due to the friction caused by the movement of the eyelids -especially in irregular and keratinized eyelid margins-, preserves the tear film, promotes a rapid symptomatic relief and improves corneal trophism by mechanisms not yet fully known. [4][5][6][7][8] Traditional tarsorrhaphy can be temporal or permanent from a timing point of view, and medial, lateral or total from a location point of view. The permanent tarsorrhaphy involves de-epithelializing the eyelid borders and suturing both superior and inferior eyelids.…”

Oftalmopati Graves: Patofisiologi, Diagnosis, dan Manajemen

“…Teori ini pertama kali dikemukakan tahun 1964, ketika suatu kasus dengue berat terjadi pada infeksi dengue sekunder. 17 Setelah terjadi infeksi primer oleh suatu serotipe virus dengue, sistem imun memproduksi antibodi yang mampu mengikat dan menetralisir infeksi sekunder dengan serotipe virus yang sama (infeksi sekunder monolog). Namun, jika terjadi infeksi sekunder dengan serotipe berbeda (infeksi sekunder heterolog), penyakit akan lebih parah.…”