Thyroid eye disease with choroidal folds

Orbit. 2021 Jun;40(3):206-214. doi: 10.1080/01676830.2020.1756347. Epub 2020 Apr 23.


Purpose: To determine the clinical course of patients with chorioretinal folds (CRF) in thyroid eye disease (TED).Methods: A multi-center retrospective case series of patients with TED who developed CRF.Results: Ten patients (17 eyes) with CRF related to TED were identified. The mean age of presentation was 59.3 ± 8.3 years old. The majority of patients were male (70%), hyperthyroid (70%), hyperopic (53%), had a history of radioactive iodine (60%), and currently on methimazole treatment (30%). Three patients (3 eyes) had unilateral involvement of CRF with bilateral TED. The average clinical activity score was 3.6 ± 2.1 at the time of presentation. The most commonly enlarged extraocular muscles were medial (76%), inferior (64%), superior (64%) and lateral rectus (35%). Compressive optic neuropathy was seen in 47% of eyes. Treatment included oral prednisone (70%), orbital decompression (59%), thyroidectomy (20%) and tocilizumab (10%). The CRF did not resolve over a follow up period of 24.7 ± 23.7 months in 70% of eyes. There was no significant difference in average axial length (25.7 ± 4.9 mm) and optic nerve to optic strut distance (37.8 ± 3.9 mm) between patients with CRF and the eight age-and sex-matched TED control patients without CRF (p = 0.81 and 0.65 respectively). A univariable and multivariable analysis found an enlarged inferior rectus as a factor in TED patients with persistent CRF.Conclusions: CRF are often an indicator of visually threatening situations and often do not resolve despite treatment of TED.

Keywords: Chorioretinal folds; Grave’s ophthalmopathy; choroidal folds; thyroid eye disease; thyroid orbitopathy.

MeSH terms

  • Aged
  • Female
  • Graves Ophthalmopathy* / diagnosis
  • Graves Ophthalmopathy* / drug therapy
  • Humans
  • Iodine Radioisotopes
  • Male
  • Middle Aged
  • Retrospective Studies
  • Thyroid Neoplasms*


  • Iodine Radioisotopes