Corneal Pathologies in Patients with Thyroid Eye Disease: Prevalence, Clinical Characteristics and Treatment

Purpose To evaluate the prevalence, clinical features, longitudinal course, and predictors of corneal involvement in patients with thyroid eye disease (TED), with particular emphasis on ocular-surface disease and orbital exposure.Methods This retrospective cohort study included consecutive adults with a confirmed diagnosis of TED who were evaluated at a multidisciplinary TED clinic. Demographic, orbital-exposure, ocular-surface, and treatment data were collected at presentation and last follow-up. Longitudinal changes in eye-level ocular-surface findings were assessed using McNemar’s test, and multivariable logistic regression was used to identify independent predictors of corneal pathology at baseline.Results A total of 121 patients (242 eyes) with TED were included, with a median follow-up of 43.0 months. Corneal pathology was documented in 74 patients (61.2%) at presentation, with bilateral involvement in 55 of these patients (74.3%). At the eye level, punctate epithelial erosions (PEE) were present in 112 eyes (46.3%), tear-film break-up time (TBUT) <10 s in 39 eyes (16.1%), exposure keratopathy in 15 eyes (6.2%), corneal opacity in 3 eyes (1.2%), and pterygium in 1 eye (0.4%). At last follow-up, corneal pathology was documented in 50 patients (41.3%). PEE, TBUT <10 s, and exposure keratopathy decreased significantly over follow-up (p < 0.001, p = 0.005, and p = 0.007, respectively), whereas the change in corneal opacity was not statistically significant (p = 0.18). Surface-preserving surgery was performed in 12 patients. Proptosis was independently associated with corneal pathology at baseline (OR 1.51 per mm, 95% CI 1.05–2.18; p = 0.026).Conclusions Corneal involvement is common in patients with TED and frequently presents bilaterally. Ocular-surface findings generally improve over longitudinal follow-up; however, some patients require surgical intervention. These findings underscore the importance of systematic ocular-surface evaluation and longitudinal monitoring in this population.