Abstract
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.