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Course of upper eyelid retraction in thyroid eye disease
  1. Dong Cheol Lee1,
  2. Stephanie M Young2,
  3. Yoon-Duck Kim3,
  4. Kyung In Woo3
  1. 1 Department of Ophthalmology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, South Korea
  2. 2 Ophthalmology, National University Health System, Singapore, Singapore
  3. 3 Ophthalmology, Samsung Medical Center, Seoul, South Korea
  1. Correspondence to Dr Yoon-Duck Kim, Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea;{at}


Aims To evaluate the natural course of upper eyelid retraction (UER) in patients with thyroid eye disease (TED) and factors affecting its course.

Methods Retrospective non-interventional cohort study in a single tertiary institution from March 2006 to March 2015 on patients with TED with (1) unilateral or bilateral UER within 6 months from initial presentation, and (2) no prior interventions nor surgical treatment for their UER. Main outcomes and measures were mean margin reflex distance 1 (MRD1) and factors associated with UER improvement.

Results There were a total of 61 patients and 81 eyes (41 unilateral and 20 bilateral UER). Mean age was 42.3±15.1 years. Mean MRD1 decreased from 6.1 mm at presentation to 4.8 mm at 12 months, and 4.4 mm at 24 months. The proportion of eyes with normalisation of lid height increased from 0% at presentation to 22.2% at 6 months, 37.0% at 12 months and 49.4% at 24 months. Mean time to normalisation of MRD1 was 18.0±12.4 months. A positive family history of TED was found to be associated with a 6.2 times lower likelihood of normalisation. Change in exophthalmometry, clinical activity score and thyroid-stimulating immunoglobulin were significantly correlated to change in MRD1 (p<0.05). There was no correlation between change in MRD1 and thyroid-stimulating hormone receptor antibodies.

Conclusion An improved knowledge of the natural history of UER in TED will allow us to better decide and evaluate the optimal management for such patients.

  • eye lids
  • orbit
  • cosmesis

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  • Contributors All authors have made substantial contributions to the (1) conception of the work; (2) the acquisition, analysis or interpretation of data; (3) drafting the work or revising it critically for important intellectual content; and (4) final approval of the version published. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The manuscript has been read and approved by all the authors, and the requirements for authorship as stated above have been met.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval The clinical study was approved by the hospital’s Institutional Review Board and adhered to the tenets of the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as online supplementary information.

  • Author note Dong Cheol Lee and Stephanie M Young are co first authors.

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