Thyroid Eye Disease Treatments: Injections, Medications, and Surgeries

Corticosteroid Injections

Who Should Use Them “We typically use corticosteroids in people with moderate-to-severe thyroid eye disease,” says Ilya Leyngold, MD, an oculofacial surgeon in Meridian, Idaho. “For the vast majority of patients, corticosteroids work fairly well at decreasing the swelling and pain.”

Pros Corticosteroids have potentially saved people from losing their vision, says Dr. Leyngold.

Cons “There are side effects to oral corticosteroids, such as high blood pressure, elevated blood sugar, gastroesophageal reflux disease, bone fractures due to brittle bone formation, hip fractures, insomnia, and severe mood changes,” says Leyngold.

“There are also a multitude of long-term side effects, such as stomach ulcers,” he says. Plus, corticosteroids don’t seem to reduce double vision or eye bulging, which are two particularly bothersome symptoms of thyroid eye disease, Leyngold says.

• Buildup of fluid in the legs
• Fatigue
• Increased risk of infection
• Loss of appetite
• Muscle weakness
• Nausea
• Weight gain in the belly, face, and neck

Biologic Medications

Who Should Use Them These medications may be an option for people with thyroid eye disease who have significant eye bulging and double vision or other symptoms that affect their daily life, says Dr. DeParis. “Treatment decisions should be individualized and made with an ophthalmologist and, often, an endocrinologist.”

Call your insurance provider to clarify your benefits, and talk to your doctor about financial assistance programs offered through the drug manufacturers.

Pros Studies have shown that both drugs improve symptoms in people with thyroid eye disease. “In separate phase 3 clinical trials, both veligrotug and teprotumumab demonstrated statistically significant improvements in eye bulging and double vision compared with a placebo,” says DeParis.

• Infusion reactions
• High blood sugar
• Hearing impairment or loss
• Worsening inflammatory bowel disease

“Oversight by the treating doctor is important when using these medications,” says Rona Z. Silkiss, MD, an oculofacial plastic surgeon and founder of Silkiss Eye Surgery in San Francisco, which works with the nonprofit Pacific Vision Foundation.

And when considering whether these medications might be right for you, “Factors such as hearing problems, diabetes, inflammatory bowel disease, and pregnancy plans [since these medications may harm a developing baby] should all be considered,” says DeParis.

Orbital Decompression Surgery or Eyelid Surgery

What It Does Orbital decompression surgery “involves making incisions around and behind the eye or removing bone to enlarge the eye socket to allow the eye to move back into place,” says Leyngold. Doing so can relieve pressure, irritation, dry eye, and more.

In cases where double vision is caused by misalignment of the eyes, your doctor may recommend surgery on the eye muscles to fix where the eyes point. Another option is eyelid surgery, which “lowers or raises the eyelids or reduces puffiness due to fat expansion,” says Silkiss.

Who Should Get It People who have stable bulging eyes or optic nerve compression that requires intervention may be good candidates for orbital decompression surgery, says Silkiss.

“People with eyelids that are too high or too low or with ‘bags’ under or above their lids [should consider eyelid surgery],” she says. And finally, people who have misaligned eyes are great candidates for motility surgery. Each of these surgeries, says Silkiss, has a great prognosis.

What to Know About It As with any surgery, there are potential complications and risks, which your surgeon can discuss with you.

• Bring pain relief
• Improve bulging
• Improve the eyelids’ ability to close over the eyes
• Reduce exposure of the eye surface
• Relieve pressure on the optic nerve, which can result in improved vision

Orbital Radiation Therapy

What It Does Orbital radiation therapy has been used for decades to decrease inflammation associated with thyroid eye disease, says Silkiss. Applied directly to the eye, this radiation can reduce eye misalignment but may not be as effective as a biologic, she says.

Counseling and Support Groups

What They Do “Stress reduction is important to deal with the negative consequences of any disease,” says Silkiss. “With thyroid eye disease, not only do the bulging eyes cause emotional stress, but the disease itself affects parts of the brain responsible for anger management and executive decision-making.

“Counseling for people with thyroid eye disease is an overlooked aspect,” she says, “because we’re so focused on the medical needs of patients versus the mental aspect.”

Who Should Use Them People with thyroid eye disease who’ve seen a decline in their quality of life and mental health are good candidates for counseling and support groups, says Yuna Rapoport, MD, MPH, founder and director of Manhattan Eye in New York City. “Constant eye discomfort makes it difficult to work and care for others, as well as do the things one used to enjoy.”

What to Know About Them Ask your healthcare provider about support groups and counseling available to people with thyroid eye disease. The American Thyroid Association provides links to a number of organizations supporting people with thyroid diseases.

Cons For some people, seeking mental health help may require overcoming a perceived stigma or other barriers. But it’s important to seek help when you need it, not only for improved mental health but also to give yourself a more robust foundation from which you can better manage the condition.