Thyroid eye disease: Established and emerging therapies

Thyroid eye disease is an immune-mediated orbital disorder most commonly associated with Graves' disease. Inflammatory expansion of orbital tissues causes proptosis, exposure symptoms, diplopia, and, in severe cases, dysthyroid optic neuropathy, with significant physical and psychological impact. Maintaining euthyroidism and promoting smoking cessation are central in its management; requiring close coordination between Ophthalmology and Endocrinology teams. Management of thyroid eye disease is guided by disease activity, severity, and phenotype, with the greatest response to immunomodulatory therapy occurring during the active inflammatory phase. Established therapies include glucocorticoids, orbital radiotherapy, steroid staring agents, whilst newer options such as biologics have expanded the therapeutic landscape. Surgical treatments are important in treating sight threatening disease refractory to medical therapy and in staged rehabilitation once disease inactivity and thyroid stability are achieved. This review outlines established as well as emerging therapies.