Graves’ Disease Eyes (Thyroid Eye Disease)

The U.S. Food and Drug Administration (FDA) in 2020 approved a medication called Tepezza (teprotumumab) to treat adults with thyroid eye disease. The move represents the first drug approved for the treatment of thyroid eye disease.

Tepezza is a specialized monoclonal antibody that specifically targets the insulin-like growth factor-1 receptor and thyroid-stimulating hormone receptor to prevent orbital fibroblasts (cells found in connective tissues) from causing inflammation and swelling in the eye socket.

Benefits

• 8 out of 10 people had less eye bulging in as few as six weeks.
• 7 out of 10 had improvement in double vision while 5-10 people had a complete resolution of double vision.
• 2 out of 3 people had resolution of pain, redness, and swelling as soon as six weeks, and improvement continued throughout their treatment with Tepezza.
• Some side effects of Tepezza can be muscle spasms, nausea, alopecia, diarrhea, fatigue, hyperglycemia, hearing impairment, dysgeusia, headache, and dry skin.

We can treat mild cases of Graves’ orbitopathy with medications, such as lubricating eye drops and steroids.

Other Medication Options

• Get prism glasses to help you with double vision. It may be possible to optically realign eyes using prisms either applied to glasses or ground into the lens. However, when prisms do not work, eye surgery may be necessary.
• Try high-dose steroid medications or radiation, or both, to improve inflammation and double vision.
• Attend support groups or take counseling to address the appearance of your eyes.
• The optic nerve can also be affected, resulting in vision loss. When it occurs, treatment is usually high-dose steroids (prednisone). For those patients who will not tolerate steroids, radiation therapy may be of benefit. If the muscles cannot be made small enough to relieve the compression of the optic nerve, then the orbit can be made larger with endoscopic orbital decompression. Since the optic nerve is usually compressed at the very back of the orbit, removing the orbit's posterior medial wall is most critical. This may be done directly (through the soft tissues or skin around the eye), through the sinus under the eye, or through the nose.

Patients can also control the severity of TED symptoms by trying these things: 

• Quit smoking. TED treatments are less effective for current smokers.
• Take selenium supplements, which are available over-the-counter.
• Take hormone therapy to keep your thyroid hormones at normal levels. Test your blood regularly and follow your doctor’s instructions, including taking prescribed medications.