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REVIEW PAPER
Ocular surface disorders and Graves’ disease
1
Chair and Clinical Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Poland
2
Department of Adult Ophthalmology, Kornel Gibiński University Clinical Center, Medical University of Silesia in Katowice, Poland
Submission date: 2026-06-02
Acceptance date: 2026-06-16
Publication date: 2026-08-28
Ophthalmology 2026;29(2):20-24
KEYWORDS
ocular surface diseasedry eye disease (DED)Graves’ diseasethyroid-associated orbitopathyClinical Activity Score (CAS)
ABSTRACT
Ocular surface disorders in thyroid-associated orbitopathy result from an autoimmune inflammatory response within the orbital fibroadipose tissue, and their severity correlates with the degree of orbital inflammatory activity. Disease-related anatomical changes lead to increased ocular surface exposure and impaired blinking biomechanics. Concurrently, tear film destabilization and local overexpression of pro-inflammatory mediators develop. This cascade disrupts ocular surface homeostasis, leading to reduced tear production and increased evaporation due to tear film instability. In the clinical management strategy, the implementation of standardized diagnostic criteria based on the latest guidelines of the Tear Film and Ocular Surface Society Dry Eye Workshop III (TFOS DEWS III) plays a key role. Optimal therapeutic management of patients with thyroid-associated orbitopathy requires an integrated approach that includes simultaneous assessment of orbital inflammatory activity and multimodal treatment of ocular surface damage.
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