Inactive Graves’ Ophthalmopathy Alters Choroidal Structure

Bulging eye (exophthalmos) due to thyrotoxicosis
Eye in thyrotoxicosis. A woman’s bulging eye (exophthalmos) due to thyrotoxicosis. The eyeball on the right is pushed forwards relative to the normal eye, giving a staring appearance. Exophthalmos is most often caused by thyrotoxicosis (over-activity of the thyroid gland). Swelling of soft tissue in the eye socket pushes the eye forwards, restricting movement and causing double vision. Treatment of the underlying thyroid disorder may relieve the condition, but sometimes surgery to relieve pressure in the eyeball may be required.
Researchers compare choroidal parameters in patients with Graves’ ophthalmopathy and control individuals.

Patients with inactive Graves’ ophthalmopathy (GO) are likely to have a thicker subfoveal choroidal thickness (SFCT) and experience changes in choroidal vascular index (CVI) and stromal area compared with individuals who do not have the disorder, according to a study published in Photodiagnosis and Photodynamic Therapy. 

Researchers conducted a prospective, masked, observational cross-sectional analysis consisting of patients with GO (n=56; mean age, 39.5±11.4 years; 30 women) and age- and sex-matched control individuals (n=64; mean age, 42.3±5.6 years; 34 women). Patients underwent ophthalmic examinations including SCFT, stromal area, luminal area, choroidal vascularity index (CVI) and retinal nerve fiber layer (RNFL) thickness measurements. Optical coherence tomography (OCT) imaging measured subfoveal (margins of 750 micrometers (μm) nasal and 750 μm temporal to the fovea, 1500 μm total) and total choroidal area (7500 μm area from the edge of the optic disc to the temporal).

Overall SFCT was significantly thicker in patients with GO compared with control individuals (311.9±30.0 vs 295.4±38.1 μm, respectively; P =.009). CV11500 and stromal area1500 were significantly different between the 2 groups (P =.009 and P =.011, respectively). Age was correlated with a thinner SFCT (P =.02) and disease duration was positively correlated with SFCT (P =.001). Luminal area1500 and stromal area1500 were negatively correlated with CVI1500 in patients with GO (P =.001 for both). Patients with GO had significantly higher intraocular pressure (IOP; P =.001) and exophthalmometer readings (P =.0001) compared with the control group.

After stratifying participants according to GO severity, mean temporal superior RNFL thickness (146.3±18.3 μm) was thicker and choroidal area7500  was higher in individuals with moderate GO compared with those with mild GO. No significant differences in other RNFL parameters were observed between groups. 

“Significantly higher IOP in GO compared to the healthy control group was seen and IOP in the moderate GO group was significantly higher than in the mild GO group,” according to the researchers. “No signs of glaucomatous nerve damage were observed in any of the patients but this indicates that regular IOP follow-up should be performed in this group of patients in terms of possible glaucomatous nerve damage.”

Study limitations include a small sample size, lack of OCT-angiography data, and failure to consider inflammatory biomarkers such as insulin like growth factor or other thyroid antibodies. 


Ceylanoglu KS, Eser NA, Sen EM. Choroidal structural evaluation in inactive Graves’ ophthalmopathy. Photodiagnosis Photodyn Ther. Published online July 9, 2022. doi:10.1016/j.pdpdt.2022.103012