Thyroid eye disease (TED) is a manifestation of autoimmune thyroid disease that threatens vision and impairs quality of life. It is caused by the activation of orbital fibroblasts, inflammation and tissue remodeling. Pathogenesis involves synergy between the thyrotropin receptor (TSHR) and the insulin-like growth factor-1 receptor (IGF-1R), which triggers intracellular signaling leading to fibroblast proliferation, glycosaminoglycan secretion, and adipogenesis. Traditional treatment includes glucocorticoids, orbital radiotherapy and surgery. A recent revolution has brought targeted biologics, particularly IGF-1R inhibition with teprotumab. Research focuses on new immunotherapies, such as Tregs, IL-6 or TNF-α. Artificial intelligence helps refine the diagnosis and prognostic assessment of TED. The review provides clinicians and researchers with an overview of the evolving management of TED.