Dysthyroid orbitopathy is an autoimmune disorder usually occurring in the setting of Graves' disease. The pathogenesis is incompletely understood but involves autoantibodies against orbital tissue. The clinical course is highly variable. Signs range from mild to severe soft tissue swelling, lid retraction, proptosis and extraocular muscle involvement with diplopia, to corneal damage and optic nerve compression with irreversible visual loss. After a few years, the phase of active inflammation is usually followed by a chronic stage with or without residual damage through fibrosis. Each stage requires a carefully adjusted therapy and optimal cooperation between the general practitioner, the ophthalmologist and other specialists involved. Therapeutic options range from topical lubricants to systemic steroids, radiation and surgery.