The natural course of upper eyelid retraction in patients with thyroid eye disease is to normalize between 12 and 18 months, according to a study in the British Journal of Ophthalmology. However, slightly less than half of the eyes in the investigation had lid normalization at two years, the study reported.

This retrospective, non-interventional cohort study included 61 patients who had both thyroid eye disease and unilateral (41 eyes) or bilateral (20 eyes) upper eyelid retraction within six months from initial presentation. All patients had no prior interventions or surgical treatments to correct the condition.

The study reported marginal reflex distance 1 (the measurement from a corneal light reflex to the center of the upper-eyelid margin) decreased from 6.1mm at presentation to 4.8mm at 12 months and 4.4mm at two years. Additionally, the proportion of eyes with normalization of lid height increased from 0% at presentation to 22.2% at six months, 37% at one year and 49.4% at two years. The average time of normalization of marginal reflex distance 1 was between approximately one year and one-and-a-half years.

Researchers noted a positive family history of thyroid eye disease was associated with a 6.2-times lower likelihood of normalization. Also, change in exophthalmometry, clinical activity score and thyroid-stimulating immunoglobulin were significantly correlated with a change in marginal reflex distance 1. Investigators also reported no correlation between change in marginal reflex distance-1 and thyroid-stimulating hormone receptor antibodies.

“An improved knowledge of the natural history of upper eyelid retraction in thyroid eye disease will allow us to better decide and evaluate the optimal management for such patients,” researchers wrote in their paper.

Lee DC, Young SM, Kim Y, et al. Course of upper eyelid retraction in thyroid eye disease. Br J Ophthalmol. May 11, 2019. [Epub ahead of print].