Graves ophthalmopathy

Graves ophthalmopathy is an autoimmune disease that affects the orbit and the adnexa. During the active phase, usually lasting from 6 months to 2 years, there is enlargement and fibrosis of the orbital fat and extraocular muscles, which can lead to ocular surface disease, abnormal extraocular motility, compressive optic neuropathy, and cosmetic impairment. Management can be divided into three broad categories: supportive, immunomodulatory, and reconstructive. When a patient's disease reaches a level of severity that requires treatment beyond supportive measures such as lubrication, immunomodulatory therapies and surgical intervention may be necessary. Methods to treat the active disease include radiation and medical treatments, with steroids or the insulin-like growth factor 1 receptor inhibitor, teprotumumab, which was FDA approved in January of 2020. Reconstructive procedures may be used to manage optic nerve compression, proptosis, eyelid malposition, and ocular misalignment. In this chapter, we address presentation, diagnosis, and management of Graves ophthalmopathy.