How should I assess the severity of Thyroid Eye Disease in a patient presenting with ocular symptoms?

To assess the severity of Thyroid Eye Disease (TED) in a patient presenting with ocular symptoms, a comprehensive evaluation of clinical signs and symptoms is crucial ². Initial assessment should focus on identifying key features such as proptosis (bulging eyes), lid retraction, diplopia (double vision), and corneal exposure ². It is also important to check for signs of optic neuropathy, as this indicates sight-threatening disease ².

Thyroid Eye Disease is typically classified based on its severity and activity ². Severity is commonly categorised as mild, moderate-to-severe, or sight-threatening ². The activity of the disease, which is often assessed using criteria like the Clinical Activity Score (CAS), helps determine if the disease is in an active or inactive phase (Alves Junior et al., 2024). This distinction is important because the effectiveness of different treatment modalities can vary significantly between the initial (active) and chronic (inactive) phases of the disease (Alves Junior et al., 2024).

Patients with suspected or confirmed TED, particularly those exhibiting moderate-to-severe or sight-threatening features, should be referred to an ophthalmologist or an endocrinologist with expertise in TED for specialist assessment and management ².