Medical Care

Medical care for patients with exophthalmos is directed at reversing the problem and minimizing ocular complications.

The FDA approved teprotumumab (Tepezza) in January 2020 for the treatment of thyroid eye disease in adults. Thyroid eye disease is most often associated with hyperthyroidism or Graves disease, although it arises from a separate process involving autoantibodies that activate an insulinlike growth factor 1 receptor–mediated signaling complex on cells within the eye orbit.

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) without deterioration in the fellow eye at week 24. Additional secondary endpoints were also met, including a change from baseline of at least 1 grade in diplopia (in 67.9% of patients receiving teprotumumab compared with 28.6% receiving placebo (P = 0.001) at week 24.^{[52, 53]}

Consultations

Once the etiology of exophthalmos or proptosis is established, the appropriate specialists should partake in the patient's care.

Long-Term Monitoring

Patients should be monitored in intervals tailored to the degree of exophthalmos and complications arising from this ocular malady. Measurement of exophthalmos, visual and color acuities, pupillary function, extraocular motilities, and visual fields should be obtained. In addition, any corneal breakdown should be assessed and remedied.

Medication

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Media Gallery

Bilateral exophthalmos and upper lid retraction secondary to Graves disease.
Exophthalmos due to thyroid dysfunction. The patient has significant forward protrusion of the eyes with bilateral upper- and lower-lid retraction. Image courtesy of Adam J. Cohen, MD.
Exophthalmos due to thyroid dysfunction. The patient has significant forward protrusion of the eyes and bilateral upper- and lower-lid retraction. Also note conjunctival injection, especially of the right inferomedial conjunctiva. Image courtesy of Adam J. Cohen, MD.