Thyroid Eye Disease & Giant Cell Arteritis

Key points

• Thyroid eye disease (Graves' ophthalmopathy): lid retraction (Dalrymple's sign), lid lag (von Graefe's), exophthalmos, ophthalmoplegia; may occur in euthyroid patients.
• Sight-threatening: optic nerve compression (check colour vision/acuity) and corneal exposure — urgent management.
• Smoking worsens thyroid eye disease; selenium for mild disease; steroids/teprotumumab for moderate-severe.
• GCA ocular involvement: amaurosis fugax/diplopia → immediate high-dose steroids before temporal artery biopsy (prevents AION blindness).

Decision points in this pathway

• Reduced acuity/colour vision or corneal exposure?

The full step-by-step algorithm, including what to do at each branch, opens in the app for approved members.