Exophthalmos (Proptosis) Medication

Updated: Jan 22, 2020
  • Author: Michael Mercandetti, MD, MBA, FACS; Chief Editor: Hampton Roy, Sr, MD  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

The FDA approved teprotumumab (Tepezza) in January 2020 for the treatment of thyroid eye disease in adults. Approval of teprotumumab was supported by the OPTIC phase 2 and 3 clinical trials (n = 171). Results showed that significantly more patients treated with teprotumumab (82.9%) had a meaningful improvement in proptosis (≥2 mm) compared with placebo (9.5%) (P ˂ 0.001). [52, 53]

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Insulinlike Growth Factor Inhibitors

Class Summary

Autoantibodies that activate an insulinlike growth factor 1 receptor–mediated signaling complex on cells within the eye orbit contribute to thyroid eye disease. Teprotumumab attenuates the actions of both IGF-1 and TSH in fibrocytes by blocking the induction of proinflammatory cytokines by TSH.

Teprotumumab (Tepezza, Teprotumumab-trbw)

Monoclonal antibody that binds insulin-like growth factor-1 receptor (IGF-1R). It is indicated for treatment of thyroid eye disease.

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Lubricants, Ophthalmic

Class Summary

Lubricants act as humectants in the eye. The ideal artificial lubricant should be preservative-free  and have a polymeric system to increase its retention time. Lubricating drops are used to reduce morbidity and to prevent complications. Lubricating ointments prevent complications from dry eyes.

Artificial tears (Celluvisc, Murine, Refresh, Tears Naturale)

Contains equivalent of 0.9% NaCl and maintains ocular tonicity. Acts to stabilize and thicken precorneal tear film and prolongs tear film breakup time, which occurs with dry eye states.

Polyethylene glycol 400/propylene glycol ophthalmic (Systane Balance, Systane Ultra, Tears Naturale Free, Hypo Tears, Murine Tears)

These substances serve as lubricants.

Carboxymethylcellulose ophthalmic (Refresh Optive Gel Drops, TheraTears Nighttime Dry Eye Therapy)

Carboxymethylcellulose is used to protect and lubricate mucous membranes surfaces and relieve dryness and irritation.

Hypromellose/carboxymethylcellulose ophthalmic (Genteal Lubricant Eye Drops, Moderate-to-Severe)

Increases lubrication of the eye, which in turn prevents complications and reduces morbidity.

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