The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on retrobulbar irradiation for thyroid eye disease.


Thyroid eye disease (also known as dysthyroid eye disease, Graves' eye disease, Graves' ophthalmopathy, or thyroid orbitopathy) is a disease that predominantly affects the extraocular muscles. It affects an estimated 400000 people in the UK assuming a 37.5 % prevalence of thyroid eye disease in Graves' disease (1). It is the most common cause of unilateral or bilateral proptosis (prominent or staring eyes) in adults, due to enlarged eye muscles and an increase in the fatty tissue behind the eyes.

Patients are commonly treated on an outpatient basis. The patient is placed in a supine position, and the head fixed with a full head shell. Irradiation is given with photons generated by a linear accelerator targeted at the retobulbar content of the orbit, and the full dose delivered in about 10 fractions over a two week period.

Coding recommendations

X65.4 Delivery of a fraction of external beam radiotherapy NEC

Y91.- External beam radiotherapy

Z16.9 External structure of eye NEC