Thyroid eye disease

Thyroid eye disease is an autoimmune, inflammatory disorder affecting the retrobulbar tissues and extraocular muscles, most frequently occurring in adults with Graves hyperthyroidism, though it can also manifest in euthyroid or hypothyroid individuals.

Pathophysiologically, autoantibodies targeting thyroid-stimulating hormone receptors and insulin-like growth factor-1 receptors on orbital fibroblasts stimulate cytokine release, glycosaminoglycan accumulation, adipogenesis, and tissue edema.

These cellular and molecular changes lead to characteristic clinical manifestations, including proptosis, eyelid retraction, periorbital edema, lagophthalmos, strabismus, and diplopia.

In advanced or severe stages, excessive orbital expansion and tissue swelling can cause compressive optic neuropathy and exposure keratopathy, presenting a substantial risk for permanent visual impairment.