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Orbital Radiation Therapy in Thyroid Eye Disease

Chundury, Rao V. M.D., M.B.A.; Weber, Adam C. M.D.; Perry, Julian D. M.D.

Ophthalmic Plastic and Reconstructive Surgery: March/April 2016 - Volume 32 - Issue 2 - p 83–89
doi: 10.1097/IOP.0000000000000544
Major Review

Purpose: To review the current literature summarizing the state of knowledge on the use of orbital radiation therapy (ORT) in thyroid eye disease.

Methods: A systematic review and analysis of the literature were performed. MEDLINE/PubMed, Cochrane Library databases, SCOPUS, and recent relevant journal articles were searched.

Results: Thyroid eye disease is an autoimmune disorder that has the propensity to affect multiple orbital tissues and can cause permanent vision loss. In moderate to severe disease, treatment may be warranted and can include multiple therapeutic modalities. Orbital radiation therapy is frequently used in this setting and may act to break the inflammatory cycle of glycosaminoglycan production and deposition. There has been a wealth of data regarding the effectiveness of ORT in thyroid eye disease resulting in the publication of treatment algorithms and management guidelines; however, there continues to be a lack of conformity among experts on the exact role of ORT in thyroid eye disease.

Conclusion: The multiple different thyroid eye disease classification schemes and the concurrent use of other therapeutic modalities challenge the interpretation of studies evaluating the effectiveness of thyroid eye disease. Despite these limitations, the current literature indicates that ORT is generally safe and well tolerated. Orbital radiation therapy may have a modest effect on motility and proptosis early in the disease process. It is unclear whether ORT leads to improved quality of life. There are some data to support the use of ORT to prevent compressive optic neuropathy.

A comprehensive literature review and analysis of the use of orbital radiation therapy in thyroid eye disease. Summary conclusions are offered.

Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A.

Accepted for publication June 29, 2015.

The authors have no financial or conflicts of interest to disclose.

Address correspondence and reprint requests to Julian D. Perry, M.D., Cole Eye Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195. E-mail:

© 2016 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.