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Thyroid eye disease
Oculoplasty
Key Points
- •TED is the most common cause of both unilateral and bilateral proptosis in adults; Graves disease accounts for ~90%
- •Tendon-sparing EOM enlargement on CT/MRI is pathognomonic of TED; if tendons are involved, consider orbital myositis or lymphoma
- •Compressive optic neuropathy (DON) can occur WITHOUT significant proptosis - 'apical crowding' at orbital apex; always check VA and colour vision
- •IV methylprednisolone (Kahaly 2005: 77% vs 51% response vs oral) is first-line for active moderate-to-severe TED; selenium for mild TED (NEJM 2011: progression 7% vs 26%)
- •Teprotumumab (FDA-approved 2020, OPTIC Phase 3: 83% proptosis response) is the first targeted biologic for TED - game-changing but expensive
- •Surgical sequence is fixed: decompression → strabismus → lids - never deviate from this order
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17 more sections are included with the Clinical plan.
- Definition
- Epidemiology
- Aetiology and causes
- Pathogenesis
- Classification
- Risk factors and associations