Thyroid eye disease (TED) affects some 400 000 people in the United Kingdom. Apart from being problematic and cosmetically distressing to patients it can be occasionally sight threatening. The joint TED clinic was first established at the New Cross Hospital in 2010. At this monthly clinic patients are assessed by both an Endocrinology and Ophthalmology consultant. Full orthoptic evaluation is done and the management plan is facilitated by a patient self-assessment questionnaire. An agreed proforma is used to capture all details. Referral criteria include active TED, patients requiring surgical input and pre-radioiodine assessment. 42 consecutive TED clinic attendees were audited over a 1 year period, of which 12 were new to the service. The average number of visits was between 2 and 3. 67% were referred for assessment of active TED. The most common symptom identified was double vision (34%). 69% of attendees were female and the average age of patients was 52. The major ethnic group represented was white British (50%). 17% were current smokers and 93% were hyperthyroid at first presentation. While the majority of patients were managed conservatively, eight patients received steroid therapy, one had botox treatment, one had lid surgery, one was listed for orbital decompression and three were referred for orbital radiotherapy. nine patients received treatment with selenium and eight patients were prescribed prisms. The audit concluded that the Wolverhampton TED service is a useful service for patients with significant eye disease. Such complex patients require early dual specialist input. Patients with active disease showed good response to steroids. There is need for close monitoring because of the risk of relapse and/or inadequate response. The vast majority need supportive measures.