Purpose

The relationship between dry eye disease (DED) severity and the clinical features of Thyroid Eye Disease (TED), including proptosis, lagophthalmos and Clinical Activity Score (CAS), remains poorly defined. This study aimed to investigate whether ocular surface severity reflects orbital disease and to identify the main clinical drivers of DED in TED.

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Methods

In this cross-sectional study, 160 consecutive Graves’ Disease (GD) patients (101 with TED, 59 without) and 67 matched healthy controls underwent a comprehensive ophthalmologic and orbital evaluation including Ocular Surface Disease Index (OSDI), non-invasive breakup time (NIBUT), tear meniscus height (TMH), meiboscore, bulbar redness, Hertel exophthalmometry, lagophthalmos and CAS.

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Results

DED prevalence increased along a severity gradient from GD without TED through mild to moderate-to-severe active TED (OR 3.53; P=0.01). OSDI was higher in moderate-to-severe active TED than in all other groups (P<0.0001) and strongly correlated with CAS (R=0.85; P<0.0001). Proptosis ≥22 mm and lagophthalmos were confirmed as independent risk factors for ocular surface disease (both P=0.001). TMH and bulbar redness correlated with CAS (P<0.0001) and remained independent predictors of active TED (P=0.0009).

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Conclusion

DED severity in GD parallels orbital disease activity: OSDI strongly correlates with CAS, while proptosis and lagophthalmos emerge as independent drivers of ocular surface damage. The ocular surface thus behaves as a clinically accessible mirror of orbital inflammation. Routine ocular surface assessment in TED could improve patient stratification, support disease monitoring and allow timely identification of patients at risk of corneal complications.

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Additional Authors

First name	Last name	Base Hospital / Institution
Filippo	Lixi	Eye Cloinic – Department of Surgical Sciences – University of Cagliari – Italy
Silvia	Corrias	Endocrinology Unit – Department of Medical Sciences – University of Cagliari – Italy
Laura	Pinna	Endocrinology Unit – Department of Medical Sciences – University of Cagliari – Italy
Claudia	Corda	Eye Cloinic – Department of Surgical Sciences – University of Cagliari – Italy
Federica	Diana	Endocrinology Unit – Department of Medical Sciences – University of Cagliari – Italy
Ludovia	Pilloni	Endocrinology Unit – Department of Medical Sciences – University of Cagliari – Italy
Stefano	Mariotti	Endocrinology Unit – Department of Medical Sciences – University of Cagliari – Italy
Francesco	Boi	Endocrinology Unit – Department of Medical Sciences – University of Cagliari – Italy
Giuseppe	Giannaccare	Eye Cloinic – Department of Surgical Sciences – University of Cagliari – Italy
Giulia	Lanzolla	Endocrinology Unit – Department of Medical Sciences – University of Cagliari – Italy

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