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The floppy thyroid eye disease.

Ayushi Agarwal1, Nandini Bothra1, Adit Gupta2

  • 1Ophthalmic Plastic Surgery Service, L.V. Prasad Eye Institute, Hyderabad, 500034, India.

International Ophthalmology
|February 23, 2026
PubMed
Summary
This summary is machine-generated.

Thyroid Eye Disease (TED) and Floppy Eyelid Syndrome (FES) can coexist, presenting unique challenges. This combination may increase globe luxation risk and mimic active TED, potentially leading to incorrect treatment.

Keywords:
Aponeurotic ptosisFloppy eyelid syndromeLash ptosisLower eyelid retractionSpontaneous globe luxationThyroid Eye DiseaseThyroid—associated orbitopathy

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Area of Science:

  • Ophthalmology
  • Endocrinology

Background:

  • Thyroid Eye Disease (TED) and Floppy Eyelid Syndrome (FES) are distinct ophthalmic conditions.
  • Co-occurrence of TED and FES is rare but presents complex clinical scenarios.

Purpose of the Study:

  • To describe the unique clinical features of patients with co-existing TED and FES.
  • To identify management challenges associated with this rare combination.

Main Methods:

  • Retrospective, multicentric, interventional case series.
  • Analysis of 9 patients (17 eyes) with co-existing TED and FES over eight years.

Main Results:

  • The average age was 51.5 years, with a near-equal male-female ratio.
  • 13 out of 17 eyes experienced spontaneous globe luxation.
  • Lower eyelid retraction was universal, while upper eyelid retraction was often masked by lax upper eyelids.

Conclusions:

  • Co-existing TED and FES can mask typical TED signs, with lower eyelid retraction being prominent.
  • Increased risk of globe luxation necessitates prompt orbital decompression.
  • Congestive signs may mimic active TED, risking inappropriate corticosteroid use.