| Sumario: | Background: Thyroid eye disease (TED) is an autoimmune inflammatory condition affecting the orbit and ocular surface, often leading to proptosis, diplopia, and evaporative dry eye. Tear film instability, eyelid retraction, and lagophthalmos contribute significantly to ocular surface dysfunction in TED. Smoking is a major risk factor that worsens disease severity and reduces treatment response. Objectives: To evaluate ocular surface changes, treatment responses, and risk factors—including smoking—in patients with TED, and to assess the effects of different therapeutic modalities. Design: Retrospective observational cohort study. Methods: This retrospective study analyzed the records of 365 patients with TED followed between 2014 and 2021. Complete clinical data were available for 362 patients. Ocular parameters, including TBUT, OSDI, Oxford staining score, MRD-1, MRD-2, and Hertel exophthalmometry, were evaluated at baseline and follow-up. Treatment modalities included antithyroid drugs, corticosteroids, selenium supplementation, RAI, and surgery. Data were compared between smokers and nonsmokers. Results: Among 362 patients (76% female), 105 (29%) were smokers. TED severity and persistent dry eye symptoms were significantly higher among smokers (p < 0.05). Posttreatment, significant improvements were observed in TBUT, OSDI, and Oxford scores (p < 0.05). Selenium supplementation showed potential benefit. CAS decreased significantly over follow-up (from 7.7% to 4.7% active cases, p < 0.05). TED progression was observed in 18.7% of patients receiving RAI therapy. Surgical intervention rates were low. Conclusion: TED causes notable ocular surface dysfunction and dry eye symptoms, particularly in smokers. Medical and surgical treatments provide effective disease control, while selenium appears promising for disease stabilization. Smoking cessation and early multidisciplinary management are critical to improving outcomes. Plain language summary: Thyroid eye disease: clinical features & therapy Thyroid eye disease (TED) is an autoimmune condition affecting the tissues around the eyes, often seen in people with thyroid disorders, especially hyperthyroidism. TED can cause symptoms such as eyelid retraction, swelling, redness, bulging eyes (proptosis), and in severe cases, vision problems due to optic nerve compression. Additionally, many patients experience dry eye symptoms, including irritation, foreign body sensation, and discomfort due to tear film instability. This study aimed to examine the eye-related changes in TED, identify risk factors affecting disease severity, and evaluate treatment outcomes. We retrospectively analyzed data from 365 TED patients at a specialized eye clinic. We assessed eye measurements, tear film stability using the tear breakup time (TBUT) test, and ocular surface damage through the Oxford staining scale. We also investigated the effects of smoking and different treatment options, including corticosteroids, selenium supplementation, radioactive iodine (RAI) therapy, and surgical interventions. The majority of patients (76%) were female, and 95.6% had hyperthyroidism. After treatment, significant improvements were observed in dry eye symptoms, TBUT, and ocular surface health. However, smoking (28.5% of patients) was linked to more severe TED and poorer treatment response. Selenium supplementation (31.77% of patients) appeared to help stabilize the disease. In contrast, 18.7% of patients who received RAI therapy experienced worsening of their TED. Our findings highlight the importance of early intervention, smoking cessation, and a multidisciplinary approach to TED management. TED not only affects the orbital tissues but also contributes to dry eye disease, making comprehensive eye care essential. Future research should focus on optimizing treatment strategies to prevent complications and improve patient outcomes.
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