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  • Oculoplastics/Orbit

    Review of: Smoking is associated with a higher risk of surgical intervention for thyroid eye disease in the IRIS Registry

    Oke I, Reshef E, Elze T, et al. American Journal of Ophthalmology, May 2023

    Investigators used data from the IRIS Registry to assess whether smoking status influenced the need for surgical interventions for thyroid eye disease (TED).

    Study design

    This was a retrospective cohort study using records from 87,774 adult patients who were diagnosed with Graves disease between 2013 and 2020. Patients were categorized by their self-reported tobacco use as current (19%), former (24%), or never (57%) smokers.


    Orbital decompression surgery was performed on 3.7% of current, 2.1% of former, and 1.9% of never smokers, while strabismus surgery was performed in 4.6%, 3.1%, and 2.2%, respectively. Eyelid recession surgery was more likely to be performed on current smokers than never smokers (4.1% vs 2.6%, respectively); former and never smokers had similar rates of eyelid recession surgery.


    As smoking status was self-reported, it is possible that the true prevalence of smoking was underestimated. In addition, individuals with undocumented smoking status were excluded, which may further underreport smoking rates. The IRIS Registry only includes patients who have been seen by an ophthalmologist, which may skew the population examined toward patients with more severe eye disease.

    Clinical significance

    Smoking is the most important modifiable risk factor for TED. This study confirms the impact smoking has on TED, showing that current smokers are more likely to undergo surgical interventions related to TED. In addition, the benefit of stopping smoking is demonstrated, as former smokers have a lower probability of undergoing surgery compared with current smokers.

    Financial Disclosures: Dr. Richard Allen discloses no financial relationships.