{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T05:04:57Z","timestamp":1783919097768,"version":"3.55.0"},"reference-count":82,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T00:00:00Z","timestamp":1783900800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:p>Thyroid eye disease (TED) is the most common orbital disorder among adults. Among its many clinical features, upper eyelid abnormalities\u2014namely, retraction, lid lag, and swelling\u2014frequently cause functional and cosmetic problems. This article reviews current knowledge on diagnosing and treating these abnormalities. We examine a range of options, from basic supportive care and local injections (botulinum toxin A, hyaluronic acid, and triamcinolone) to systemic drugs (corticosteroids, Teprotumumab, and alpha-1 antagonists) and surgery (levator recession, blepharotomy, and orbital decompression). Recent data suggest that IGF-1 receptor antagonists, especially Teprotumumab, can substantially reduce eyelid retraction and proptosis with a better safety profile than traditional glucocorticoids. Nevertheless, important questions remain: few head-to-head trials exist, the optimal timing for biologics versus surgery is unclear, and treatment needs to be individualized. Future studies should integrate artificial intelligence for quantitative eyelid assessment and promote multidisciplinary care. This review offers a practical framework for clinicians and outlines their research priorities.<\/jats:p>","DOI":"10.3389\/fendo.2026.1860864","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T04:24:02Z","timestamp":1783916642000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnosis and treatment progress of upper eyelid abnormalities in thyroid-eye disease"],"prefix":"10.3389","volume":"17","author":[{"given":"Cheng","family":"Gai","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong First Medical University","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bing","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Shandong Provincial Hospital Affiliated to Shandong First Medical University","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,13]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1038\/s41574-024-01016-5","article-title":"Graves disease: latest understanding of pathogenesis and treatment options","volume":"20","author":"Lanzolla","year":"2024","journal-title":"Nat Rev Endocrinol"},{"key":"B2","article-title":"Etiology, pathogenesis and research progress of immunotargeted therapy for thyroid-associated ophthalmopathy","volume":"60","author":"He","year":"2020","journal-title":"Shandong Med J (in Chinese)"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1080\/01676830.2018.1474237","article-title":"Simultaneous ipsilateral transconjunctival repair of upper and lower eyelid retraction in thyroid-associated ophthalmopathy","volume":"38","author":"Lee","year":"2019","journal-title":"Orbit"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-21-0479","article-title":"The 2021 European Group on Graves' orbitopathy (EUGOGO) clinical practice guidelines for the medical management of Graves' orbitopathy","volume":"185","author":"Bartalena","year":"2021","journal-title":"Eur J Endocrinol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1136\/bjo-2022-322442","article-title":"Presentation of Graves' orbitopathy within European Group on Graves' orbitopathy (EUGOGO) centres from 2012 to 2019 (PREGO III)","volume":"108","author":"Schuh","year":"2023","journal-title":"Br J Ophthalmol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/s0002-9394(14)70276-4","article-title":"Clinical features of Graves' ophthalmopathy in an incidence cohort","volume":"121","author":"Bartley","year":"1996","journal-title":"Am J Ophthalmol"},{"key":"B7","article-title":"Re-evaluating the therapeutic value of orbital decompression for thyroid-associated ophthalmopathy","volume":"48","author":"Xiao","year":"2012","journal-title":"Chin J Ophthalmol (in Chinese)"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000004469","article-title":"Aponeurosis of the levator palpebrae superioris in Chinese subjects: a live gross anatomy and cadaveric histological study","volume":"95","author":"Pan","year":"2016","journal-title":"Med (Baltimore)"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(25)00066-X","article-title":"Thyroid eye disease (Graves' orbitopathy): clinical presentation, epidemiology, pathogenesis, and management","volume":"13","author":"Wiersinga","year":"2025","journal-title":"Lancet Diabetes Endocrinol"},{"key":"B10","article-title":"Qualitative and quantitative analyses of M\u00fcller's muscle in dysthyroid ophthalmopathy","volume":"31","author":"Kagoshima","year":"1987","journal-title":"Jpn J Ophthalmol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.survophthal.2026.01.003","article-title":"Exploring successful treatments for upper eyelid retraction in thyroid eye disease: A scoping review","volume":"71","author":"Salh","year":"2026","journal-title":"Surv Ophthalmol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2005-1877","article-title":"Molecular pathology of M\u00fcller's muscle in Graves' ophthalmopathy","volume":"91","author":"Shih","year":"2006","journal-title":"J Clin Endocrinol Metab"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/s0161-6420(89)32874-0","article-title":"Enlargement of levator palpebrae superioris muscle fibers in Graves' ophthalmopathy","volume":"96","author":"Small","year":"1989","journal-title":"Ophthalmology"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1016\/s0161-6420(94)38033-x","article-title":"Fixation duress in the pathogenesis of upper eyelid retraction in thyroid orbitopathy. 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