Exophthalmos is an ocular condition in people with thyroid disease, most notably Grave’s disease. It occurs when the immune...
Thyroid Eye Disease Treatments
Evolution of Thyroid Eye Disease Treatments
This rare complication of thyroid disease has few treatment options. Intravenous steroids are given to reduce the inflammation and pain but the anatomical changes are primarily corrected surgically. There are three primary types of surgery performed to treat exophthalmos and its associated complications. The surgeon can either remove a small section of bone and fat from within the orbit during orbital decompression surgery. This allows for better positioning of the eyeball within the bony orbit of the skull as it frees up space and the eye is no longer competing with surrounding overgrown muscles and tissues. In exophthalmos since the eye bulges beyond the eyelid, surgery can be performed to reposition the eyelid in an effort to have it close over the eye. Finally, if the eye protrudes to a degree that causes double vision the surgeon can perform extraocular muscle repositioning. Numbness, post-operative swelling, nerve damage, and bruising are some complications of thyroid eye disease surgeries.
Tepezza was created in an effort to provide a nonsurgical option for thyroid eye disease. It is a human monoclonal antibody and the first drug approved for this condition. Monoclonal antibodies are proteins made in a laboratory that mimic human antibodies and in this case works to prevent the immune system’s attack on cells. This particular drug works as an insulin-like growth factor receptor inhibitor. Insulin-like growth factors are key mediators in the stimulation of muscle and fatty tissue behind the eye that leads to swelling and expansion within the confined space of the orbit. Once the receptors on the cells are inhibited by tepezza, stimulation of fat and muscle is blocked. After a total of eight infusions over 24 weeks, it has been demonstrated to cause a 2mm or better regression of proptosis. This innovative method of achieving regression of eye protrusion gives people with exopthalmos a nonsurgical option that did not exist prior to this medication.