• AAO OTAC Oculoplastics/Orbit Panel, Hoskins Center for Quality Eye Care
    Oculoplastics/Orbit
    A report by the American Academy of Ophthalmology Ophthalmic Technology Assessment Committee Oculoplastics and Orbit Panel

    Rachel K. Sobel, MD,1 Vinay K. Aakalu, MD, MPH,2 M. Reza Vagefi, MD,3 Jill A. Foster, MD,4 Jeremiah P. Tao, MD,5 Suzanne K. Freitag, MD,6 Edward J. Wladis, MD,7 Timothy J. McCulley, MD,8 Michael T. Yen, MD9

    Ophthalmology, In Press, © 2021 by the American Academy of Ophthalmology. Click here for free access to the OTA. 

    Purpose: To review the current literature on the safety and efficacy of orbital radiation for the management of thyroid eye disease (TED).

    Methods: A literature search was conducted last in February 2021 of the PubMed database to identify all articles published in the English language on original research that assessed the effect of orbital radiation on TED. The search identified 55 articles, and 18 met the inclusion criteria for this assessment. A panel methodologist than assigned a level of evidence rating for each study, and all of them were rated level III.

    Results: Two large retrospective studies demonstrated the efficacy of radiation treatment, with or without corticosteroid use, in preventing or treating compressive optic neuropathy (CON). Three studies highlighted the role of orbital radiation therapy (RT) to facilitate the tapering of corticosteroids. Several other studies showed a possible role for RT to improve diplopia and soft tissue signs.

    Conclusions: Although no level I or level II evidence exists, the best available evidence suggests that orbital radiation, used with or without corticosteroids, is efficacious in preventing CON, improving motility restriction, and decreasing clinical activity in TED. Orbital radiation also may facilitate a corticosteroid taper. Together, these studies show that RT seems to modify the active phase of TED. Short-term risks of orbital radiation are minor, but long-term outcome data are lacking. 

    1Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee
    2Illinois Eye and Ear Infirmary, University of Illinois College of Medicine at Chicago, Chicago, Illinois
    3Department of Ophthalmology, University of California San Francisco, San Francisco, California
    4Ophthalmic Surgeons and Consultants of Ohio, Columbus, Ohio
    5Gavin Herbert Eye Institute, University of California, Irvine School of Medicine, Irvine, California
    6Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
    7Ophthalmic Plastic Surgery, Lions Eye Institute, Department of Ophthalmology, Albany Medical Center, Albany (Slingerlands), New York
    8Ruiz Department of Ophthalmology and Visual Sciences, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas
    9Cullen Eye Institute, Baylor College of Medicine, Houston, Texas