Thyroid eye disease is diagnosed based on characteristic eye signs in the context of current or past thyroid dysfunction. Assessment focuses on confirming the diagnosis, grading severity, and identifying sight‑threatening complications.
Clinical Assessment
A detailed history and examination document symptoms such as grittiness, tearing, double vision, and changes in appearance.
- Findings may include eyelid retraction, proptosis, restricted eye movements, and conjunctival or caruncle swelling.
- Visual acuity, colour vision, visual fields, and pupil responses are checked to assess optic nerve function.
- Hertel exophthalmometry measures the degree of eye protrusion.
- Activity and severity scores (for example, CAS or EUGOGO classifications) help guide treatment decisions.
Investigations
Laboratory and imaging tests support the diagnosis and rule out other orbital disease.
- Thyroid function tests and thyroid autoantibodies are measured, even if systemic disease is already known.
- Orbital CT or MRI shows enlargement of extraocular muscles and fat and can detect optic nerve crowding.
- Baseline photographs and, when needed, visual field and OCT scans allow ongoing monitoring.
- Multidisciplinary review with endocrinology ensures both thyroid status and eye disease are optimally managed.
