Purpose

To summarize and establish a reproducible framework of radiological parameters reported in the literature for the assessment of dysthyroid optic neuropathy (DON), with emphasis on measurement definitions, imaging planes, and clinical relevance.

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Methods

A structured narrative review of peer-reviewed literature published between 2000 and 2025 was performed. Systematic searches were conducted in PubMed, Scopus, EMBASE, Google Scholar, and the Cochrane Library to identify studies reporting quantitative CT- and MRI-based orbital measurements in thyroid eye disease. Radiological parameters were classified into three domains: bony orbital geometry, soft-tissue measurements, and composite or ratio-based indices. For each parameter, standardized definitions, imaging planes, and measurement techniques were extracted. Reported clinical associations were synthesized descriptively.

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Results

Multiple bony and soft-tissue parameters have been reported to be associated with DON, reflecting both fixed orbital geometry and acquired soft-tissue expansion. Narrow medial or lateral wall angles (<88° and 60% demonstrate the highest diagnostic accuracy and reproducibility Composite indices, integrate bony and soft-tissue features and demonstrate moderate-to-high diagnostic performance across studies, although reported thresholds vary.

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Conclusion

Quantitative radiological parameters provide objective support for the diagnosis of DON; however, substantial heterogeneity exists in imaging protocols, measurement techniques, and diagnostic thresholds. The parameters summarized in this review should be regarded as complementary tools rather than definitive criteria. Further prospective validation and standardization are required before widespread clinical adoption.

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Additional Authors

First name	Last name	Base Hospital / Institution
Shahad	Alruwaili
Rahaf	Almutairi
Hamad	Alsuliman
Osama	Alsheik
Sahar	Elkhamary
Abdullah	Almater
Diego	Strianese
Khawlah	alzaben

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