Assessment of Ocular Misalignment Before and After Teprotumumab Therapy in Patients With Thyroid Orbitopathy

Diplopia due to thyroid orbitopathy can be disabling with limited management options that include prisms or strabismus surgery. Teprotumumab, an insulin like growth factor one (IGF-1) antagonist, reduces proptosis and improves double vision. Two clinical trials previously reported subjective improvement in diplopia in 68% (45/66) of patients who received teprotumumab, although neither documented objective measurements of ocular alignment (Smith et al.,2017; Douglas et al.,2020). We sought to objectively measure ocular misalignment in patients receiving teprotumumab before and after therapy.