Thyroid-associated ophthalmopathy (TAO), also known as Graves’ ophthalmopathy (GO), is an autoimmune disease involving the orbital tissues associated with thyroid disease. It is the most prevalent orbital disease in adults. Thyroid-related ophthalmopathy can occur in patients with hyperthyroidism, hypothyroidism, normal thyroid function, and in a small percentage of patients with Hashimoto’s thyroiditis. Studies have shown that about 60% of patients with normal thyroid TAO will develop hyperthyroidism within 6 years, so they should be monitored dynamically for early detection of changes in thyroid function. Classification: Clinically, TAO is often divided into two types: the first type is Graves’ ophthalmopathy with abnormal thyroid function, which is common in young and middle-aged women and mostly develops in both eyes. The other type is ocular Graves’ disease with ocular signs only and normal thyroid function, which is more common in middle-aged males and mostly develops unilaterally or sequentially in both eyes. Epidemiological features: The disease is genetically related. The onset of the disease is bimodal, with a peak around 40 years of age and a secondary peak around 60 years of age. It is more common in women than in men, with a male:female ratio of 3:16. It is more prevalent in Europeans than in Asians. Occurrence and progression are associated with many factors, such as smoking, abnormal thyroid function and different forms of hyperthyroidism treatment (iodine 131 therapy). Smoking: it can promote the development of TAO, accelerate the deterioration of early TAO, reduce the effectiveness of TAO treatment and accelerate the progression of TAO after radiation therapy. Staging: The natural course of the disease is divided into two stages: the early stage is the active stage, which lasts from 8 months to 3 years and mainly manifests as ocular lymphocytic infiltration, edema and activation of fibroblasts. The late stage is the inactive stage, which is characterized by fibrosis and fatty deposits. Clinical manifestations: Most TAO is relatively mild and self-limiting, with only 3-5% of patients having visual impairment. Symptoms: photophobia, tearing, foreign body sensation; ocular pain, periorbital pain; eye redness; diplopia; blurred, decreased, or blind vision. Signs: eyelid recession, late fall of the upper lid, protrusion of the eyeball, eyelid congestion and swelling, ocular motility disorders, conjunctival congestion, edema, and increased intraocular pressure. The most common first symptom is eyelid recession (normal eyelid position: upper lid margin 1-2 mm below the corneal margin, lower lid margin at or above the corneal margin). Ancillary examinations: ophthalmologic examinations: prominence of the eye, lid height, lid position, intraocular pressure, routine examination of the anterior and posterior segments of the eye, and diplopia imaging: orbital ultrasound, CT (coronal and sagittal), and MRI. Laboratory tests such as thyroid function and thyroid autoantibody test Treatment: Basic treatment includes quitting smoking, paying attention to eye hygiene and more rest for the eyes. Wear tinted glasses, use artificial tears, cover the cornea at night to protect the cornea, elevate the head of the bed to reduce periorbital edema, and wear prismatic lenses to correct mild diplopia. Treatment is chosen according to its activity and severity. 1. Mild TAO usually requires only close observation and follow-up. Local treatment of the eye is usually effective, and mild TAO will resolve when the hyperthyroidism resolves. If they are dissatisfied with their psychosocial functioning and quality of life due to eyelid recession, tissue edema, and proptosis, they may also undergo relevant treatment after weighing the pros and cons. 2, Patients with moderate to severe thyroid-related ophthalmopathy in its active phase are often treated with immunosuppressive therapy such as hormones, or radiation therapy; inactive patients with moderate to severe TAO may be considered for rehabilitation surgery (eyelid regression correction, orbital decompression, eye muscle surgery, etc.). 3, For patients with very severe sight-threatening TAO, systematic hormone therapy and/or surgery are commonly used. Orbital decompression can quickly relieve the symptoms of patients with sight-threatening TAO and save the patient’s eye and vision.