What is the initial treatment for Graves' eye disease?

From the Guidelines

The initial treatment for Graves' eye disease should focus on symptom management, including the use of ocular lubricants, such as artificial tears, and cessation of smoking, as recommended in the adult strabismus preferred practice pattern 1. When managing Graves' eye disease, it is essential to consider the patient's overall quality of life and morbidity. The treatment approach should prioritize alleviating symptoms and preventing further complications.

• Ocular lubricants, such as artificial tears, are almost always needed to combat exposure related to eyelid retraction and proptosis, as stated in the adult strabismus preferred practice pattern 1.
• Patients should be counseled to cease smoking, as smoking can worsen symptoms and reduce treatment effectiveness 1.
• Selenium supplementation may be beneficial in patients with selenium deficiency, as it has been shown to reduce some inflammatory symptoms in patients with milder TED 1.
• In cases of moderate to severe inflammation, treatment with teprotumamab, a human monoclonal antibody inhibitor of IGF-IR, may be considered, as it has been demonstrated to attenuate the actions of IGF-I, thyrotropin, thyroid-stimulating immunoglobulins, and immunoglobulins in patients with Graves’ disease 1.
• Orbital decompression, high-dose steroids, or radiation treatment should be considered for severe proptosis or optic neuropathy, as indicated in the adult strabismus preferred practice pattern 1.
• Surgery may be required in most patients with persistent diplopia in primary or reading positions of gaze, usually undertaken when the inflammatory stage has subsided and the angle of deviation has been stable for at least 6 months 1.

From the FDA Drug Label

In patients with Graves’ disease with hyperthyroidism or toxic multinodular goiter for whom surgery or radioactive iodine therapy is not an appropriate treatment option. The FDA drug label does not answer the question.

From the Research

Initial Treatment for Graves' Eye Disease

The initial treatment for Graves' eye disease typically involves the use of corticosteroids.

• Corticosteroids are the first choice of treatment for Graves' ophthalmopathy, with high-dose intravenous corticosteroid pulse therapy often used in cases of severe ophthalmopathy 2, 3.
• Oral corticosteroids, such as prednisone, can also be effective in treating moderate-to-severe Graves' ophthalmopathy, and may be preferred in pediatric patients due to the importance of quality of life 4.
• The treatment regimen for corticosteroids can vary, but typically involves an initial high dose that is gradually tapered off over several weeks or months 2, 3, 5, 6.
• In addition to corticosteroids, other treatment options for Graves' eye disease may include orbital radiotherapy, surgical decompression, and immunosuppressive or immunomodulating agents 5.

Factors Influencing Treatment Choice

The choice of treatment for Graves' eye disease can depend on several factors, including:

• Disease severity: Patients with mild disease may require less aggressive treatment, while those with more severe disease may require higher doses of corticosteroids or additional treatments 2, 3, 5, 6.
• Disease activity: Patients with active disease may require more intensive treatment to reduce inflammation and prevent progression 2, 3, 5.
• Patient age and health status: Pediatric patients may require special consideration due to the importance of quality of life, while patients with certain health conditions may require adjusted treatment regimens 4.