While retraction, fullness, proptosis, and extra-axial globe dystopia have been shown to be aesthetic characteristics of thyroid eye disease (TED), changes in the vertical position of the eye have not been well-characterized among patients with TED.

To determine if vertical globe displacement occurs in patients with TED and intraconal tumors (ICT) when compared with controls and to evaluate whether surgery affects vertical globe position in this patient population, researchers assessed data on 171 patients with TED, 37 patients with ICT, and 61 controls. Although each of the three groups had a similar age distribution, 80% of patients with TED were female, compared with 59% of those with ICT and 67% of controls. Primary outcomes were vertical globe position, as measured by a line drawn between lateral canthi to the center of each pupil, and changes in this position in patients with TED or ICT who undergo surgery. Secondary outcomes included the correlation between interpupillary distance (IPD), proptosis, and vertical globe position; and correlation in IPD, proptosis, and vertical globe position after surgery.

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Mean vertical globe positions were 1.6 (SD, 1.4) for patients with TED, 2.1 for patients with ICT (SD, 1.0), and 2.2 (SD, 1.1.) for controls. IPD was larger in patients with TED (mean, 62.5; SD, 4.4) and ICT (mean, 62.2; SD, 4.7) than in controls (mean, 59.6; SD, 3.4; P<0.001). Proptosis was greater in patients with TED (mean, 24.2 mm; SD, 3.3) than in patients with ICT (mean, 20.9 mm; SD, 4.5; P=0.001). After adjusting for race, age, and sex, patients with TED had significantly lower mean vertical globe position when compared with those with ICT and controls. Among 30 patients with TED who had orbital imaging, neither superior rectus (P=0.842) or interior rectus enlargement (P=0.837) were predictive of vertical globe position. Surgery also did not appear to affect vertical globe position in patients with TED (P=0.396) or ICT (P=0.786), as was the case with decompression type.

“Further studies on the role or orbital geometry on aesthetic outcomes and globe position will be useful in refining rehabilitative treatment algorithms in TED,” concluded the study authors.