Principles of treatment for thyroid-related eye disease

  The European Group on Graves’ orbitopathy (EUGOGO) is an organization dedicated to providing the best evidence-based evidence for the diagnosis and treatment of thyroid-related ophthalmopathy (hyperthyroidism), and has published a large number of guiding papers on thyroid-related ophthalmopathy (hyperthyroidism). EUGOGO has published a number of guiding papers on thyroid-related eye disease (hyperthyroidism).  EUGOGO emphasizes that the priority of management of thyroid-related eye disease should be determined by the condition, and that treatment options for thyroid-related eye disease vary by stage, severity, and presentation.  Mild thyroid-related ophthalmopathy is often self-limiting and does not progress to moderate-to-severe TAO, and is treated primarily with basic therapy, often without immunosuppressive therapy. Basic treatment includes: 1) mandatory smoking cessation; 2) effective control of thyroid function; 3) local protective measures, including artificial tears, lubricating eye ointment, and corneal contact lenses.  2. Moderate-severe thyroid-related ophthalmopathy On the basis of the treatment measures for mild TAO, non-surgical treatment and/or surgical treatment can be chosen, taking into account the patient’s condition (active or inactive). Immunosuppressive therapy, including glucocorticoids, orbital radiotherapy, growth inhibitor analogs, immunosuppressants, immunoglobulins, etc., should be given during the active phase; when the orbital lesion is in the resting phase, rehabilitative surgical treatment (in the order of orbital decompression, strabismus correction, eyelid lengthening, and eyelid shaping) can be given.  3. Very severe thyroid-related eye disease Treatment of abnormal thyroid function with optic neuropathy: Radiotherapy is not recommended. Systemic use including glucocorticoids and orbital decompression surgery are the recommended treatments. Intravenous infusion of high-dose glucocorticoids is the treatment of choice for patients with thyroid dysfunction with optic neuropathy; orbital decompression surgery is indicated if intravenous infusion of glucocorticoids for 1 to 2 weeks is ineffective or if serious adverse effects occur during treatment. Orbital decompression surgery should be performed immediately in patients with thyroid dysfunction with optic neuropathy who cannot tolerate treatment including glucocorticoids. Patients with corneal detachment should be considered emergent and require urgent temporary treatment measures to promote corneal recovery (e.g., lid sutures, lid margin sutures) and treatment measures to prevent corneal infection (e.g., antibiotics).