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Thyroid eye disease (TED), also known as thyroid-associated ophthalmopathy (TAO), thyroid orbitopathy, Graves’ orbitopathy, or Graves’ ophthalmopathy (GO), causes orbital congestion and proptosis due to extraocular muscle and orbital fat enlargement with fibrosis. These anatomical alterations can result in compressive optic neuropathy, exposure keratopathy, and ocular motility disorders. Treatment of proptosis from thyroid eye disease consists of orbital decompression, taking advantage of the adjacent sinus spaces to expand orbital volume. Based on patient presentation, the amount of decompression required is determined on a case-by-case basis. This activity illustrates the evaluation and management of patients with Graves' ophthalmopathy and highlights the role of the interprofessional team in improving care for patients with this condition. Objectives: Assess the pathophysiology of Graves' ophthalmopathy. Evaluate the typical presentation of a patient with Graves' ophthalmopathy. Determine the treatment of Graves' ophthalmopathy. Communicate the importance of collaboration and communication amongst the interprofessional team to improve outcomes for patients affected by Graves' ophthalmopathy. Access free multiple choice questions on this topic.

Thyroid eye disease (TED), or thyroid-associated ophthalmopathy (TAO), thyroid orbitopathy, Graves’ orbitopathy, or Graves’ ophthalmopathy, causes orbital congestion and proptosis due to extraocular muscle and orbital fat enlargement with fibrosis[1]. These anatomical alterations can result in compressive optic neuropathy, exposure keratopathy, and ocular motility disorders. Treatment of proptosis from thyroid eye disease consists of orbital decompression, taking advantage of the adjacent sinus spaces to expand orbital volume. Based on patient presentation, the amount of decompression required is determined on a case-by-case basis. For example, in cases of moderate to severe proptosis, medial wall, lateral wall, and floor decompression can be done, taking advantage of the adjacent ethmoid sinuses, maxillary sinus, and orbital trigone, respectively.

The complications that can manifest with Graves Disease orbital decompression include the following: Orbital hemorrhage Orbital compartment syndrome Optic nerve injury Infection Diplopia Restricted motility Subconjunctival hemorrhage Vision loss Globe dystopia Globe rupture Hypoesthesia (V2) Eyelid retraction or ptosis Vitreous hemorrhage Retinal detachment Cerebrospinal fluid leak[7] Lacrimal drainage system injury Keratopathy Scarring Lid laxity/malposition Canthal angle distortion

When patients with Graves' ophthalmopathy present with visual changes, a prompt referral to an ophthalmologist should be made. If surgery is necessary, the primary care provider, nurse practitioner, and endocrinologist should optimize the patient's functional status. In most patients with acute ocular symptoms, urgent decompression is required. The outcomes depend on the chronicity of the condition and the extent of optic nerve damage.