갑상샘눈병증으로 인한 위눈꺼풀뒤당김에서 눈꺼풀절개술의 임상 효과

안소은,이화,장민욱,이종미,신형호,백세현,Soh-Eun Ahn,Hwa Lee,Minwook Jang,Jongmi Lee,Hyoungho Sin,Sehyun Baek 대한안과학회 2012 대한안과학회지 Vol.53 No.7

Purpose: To investigate the clinical efficacy of blepharotomy to treat upper eyelid retraction associated with thyroid eye disease. Methods: A retrospective survey was performed with 9 eyes of 7 thyroid ophthalmopathy patients, who visited Korea University Medical Center from August 2009 to February 2011, and had undergone blepharotomy. The sex, age, change of upper eyelid retraction, postoperative complication, follow-up periods, and the surgical results were reviewed. To assess the efficacy of blepharotomy more objectively, the preoperative and postoperative pictures of patients were taken and the following lid parameters measured: marginal reflex distance 1, interpalpebral fissure height, total palpebral fissure area, upper nasal palpebral fissure area, and upper temporal palpebral fissure area. Results: The mean age of patients was 37.4 years and mean follow-up period was 12.8 months. Five patients had undergone surgery unilaterally and 2 patients, bilaterally. Seven eyes of 6 patients had undergone full thickness blepharotomy and 2 eyes of 1 patient had undergone graded blepharotomy. According to the 3-month preoperative and postoperative picture analysis, all lid parameters improved significantly after blepharotomy (2.03 mm, 1.95 mm, 24.28 mm2, 12.98 mm2, and 16.21 mm2, respectively). Complications associated with blepharotomy included multiple and high folds in 2 eyes of 2 patients who had undergone full thickness blepharotomy. Re-operation was performed on only 1 eye and the result was satisfactory. Conclusions: Blepharotomy for upper eyelid retraction is a safe and highly effective surgery for upper eyelid retraction associated with symptomatic thyroid eye disease. This technique achieves excellent functional and cosmetic outcomes. J Korean Ophthalmol Soc 2012;53(7):911-917

갑상샘눈병증에 동반되어 나타난 3번 뇌신경 마비 1예

허준,전혜신 대한검안학회 2023 Annals of optometry and contact lens Vol.22 No.3

목적: 그레이브스병이 있는 환자에서 발생한 갑상샘눈병증 및 3번 뇌신경 마비가 스테로이드 치료에 양호한 반응을 보여 이를 보고하고자 한다. 증례요약: 그레이브스병 치료 중인 50세 여자가 한 달 전 시작된 양안 수직 복시로 내원하였다. 복시는 지속적이며 일중변동이 없었고우안의 상전제한을 보였다. 안와 전산화단층촬영에서 양안의 하직근의 비대가 관찰되었다. 12일 후 환자는 복시가 심해짐을 호소하였고 좌안 내전 및 하전 제한과 이에 상응하는 좌안 상사시, 외사시 소견을 보였다. 강제견인검사에서 제한은 없었다. 갑상샘눈병증과병발한 3번 뇌신경 마비로 진단하고 고용량 스테로이드 정맥주사 요법을 시행하였고 치료 한 달째 안구운동 및 사시 소견은 모두호전되었으며 증상 발생 후 9개월까지 증상 재발 및 변화는 없었다. 결론: 갑상샘눈병증이 발생한 환자에서 좌측 3번 뇌신경 마비가 동반되었다. 갑상샘눈병증이 침범한 근육과 일치하지 않는 안구운동장애가 나타나거나 강제견인검사 음성인 경우 뇌신경 마비의 동반가능성을 생각하여야 한다. Purpose: To report a patient who developed thyroid eye disease and third cranial nerve palsy at the same time and showed good response to high dose steroid therapy. Case summary: A 50-year-old woman who was diagnosed with Graves' disease presented with binocular vertical diplopia for 1 month. Diplopia was persistent and did not show any fluctuation daily. Up gaze was limited in the right eye. Orbital computed tomography showed hypertrophy of the inferior rectus muscles in both eyes. After 12 days, she complained of rapid progression of diplopia. Adduction and down gaze were limited in the left eye, and left hypertropia and exotropia were presented. Steroid pulse therapy was administered, and eye movements and strabismus improved at one month after treatment, and there were no recurrences until 9 months after symptom onset. Conclusions: Thyroid eye disease was accompanied by third cranial nerve palsy. If ocular movement is not consistent with the extraocular muscle involved or the forced duction test result in thyroid eye disease, the possibility of combined cranial nerve palsy should be considered.

Optic Neuropathy in Thyroid Eye Disease: A Case Series

Nur Aqilah Salleh,Wong Hon Seng,Hazlita Dato’ Mohd Isa 대한가정의학회 2016 Korean Journal of Family Medicine Vol.37 No.3

In patients with thyroid disease, ocular involvement or thyroid ophthalmopathy is common, irrespective of theirthyroid status. A common feature of thyroid eye disease is eyelid retraction, which leads to a classical starry gaze(Kocher sign). Treatment with radioactive iodine (RAI) is a known therapy for hyperthyroidism. However, this treatmentmay lead to or worsen thyroid ophthalmopathy. We report a case series of two patients with thyrotoxicosis,who presented with an atypical and subtle occurrence of thyroid eye disease (TED) soon after RAI therapy. One ofthe patients was initially diagnosed and treated for dry eyes; however, over a period of time, the patient’s vision progressivelydeteriorated. Clinical and radiological investigations confirmed thyroid ophthalmopathy with low serumthyroid hormone levels. Both patients recovered well after immediate intensive intravenous steroid treatment. These cases highlight the importance of recognizing partial ptosis as one of the presenting signs of active TEDamong general practitioners and physicians.

A Review of Novel Medical Treatments for Thyroid Eye Disease

Jeong Woo Park,Jin Sook Yoon 대한안과학회 2024 Korean Journal of Ophthalmology Vol.38 No.3

Thyroid eye disease (TED) is the most common extrathyroidal manifestation of Graves disease. There has been no effective medication to prevent proptosis in thyroid eye disease until 2020 when the anti–insulin-like growth factor 1 receptor (anti–IGF-1R) antibody, Teprotumumab, was approved by the US Food and Drug Administration, sparking increased interest in immune-based drug development. This study aims to review the newly developed drug therapy as well as conventional treatment for TED. Treatment of TED has traditionally been high-dose steroids and orbital radiotherapy, but recently there has been a paradigm shift in the treatment of TED in the United States with the introduction of the therapeutic agent teprotumumab, which dramatically reduces proptosis. However, concerns remain about the development of hearing impairment as a potentially fatal complication and long-term safety. Recently, several clinical trials are underway to assess the efficacy and safety of novel drugs targeting mammalian target of rapamycin complex 1, interleukin-6, fragment crystallizable receptor, and IGF-1R in treating TED. With the explosive increase in interest from academia and pharmaceutical companies in TED, there is anticipation for the development of drugs that are equivalent or superior to teprotumumab while being safer.

혈청 갑상샘자극호르몬수용체 자가항체와 갑상샘눈병증의 중증도 및 활동성과의 관계

이제상(Je Sang Lee),이시형(Si Hyung Lee),김보연(Bo Yeon Kim),장선영(Sun Young Jang) 대한안과학회 2021 대한안과학회지 Vol.62 No.11

목적: 혈청 갑상샘자극호르몬수용체 자가항체 농도와 갑상샘눈병증(thyroid eye disease) 활성도 및 중증도와의 연관성을 관찰하고자 한다. 대상과 방법: 2014년 3월부터 2019년 12월까지 갑상샘눈병증으로 진단된 315명의 환자의 단면조사연구를 시행하였다. 질환의 활성도 평가를 위해 질병활성도(clinical activity score)가 사용되었고, 중증도 평가는 modified NOSPECS score가 사용되었다. 혈청 갑상샘자극호르몬수용체 자가항체 농도는 두 가지 분석법으로 측정되었다: 갑상샘자극호르몬 결합억제 면역글로불린(TSHR binding inhibitory immunoglobulin, TBII) 측정법과 갑상샘자극면역글로불린(thyroid stimulating immunoglobulin, TSI) 측정법. 각 분석법의 검사 결과, 갑상샘눈병증 활성도/중증도 상관관계를 분석하였다. 결과: 두 분석법(TBII, TSI)에서 갑상샘자극호르몬수용체 자가항체 농도와 질병활성도(각각, R=0.113, R=0.211; p<0.05), 중증도(각각, R=0.173, R=0.316; p<0.05), 안구돌출(각각, R=0.136, R=0.167; p<0.05)이 유의한 상관관계를 보였다. 또한, 압박시신경병증, 각막상피결손 유무에서도 유의한 차이를 보였다. 결론: 두 분석법을 이용한 갑상샘자극호르몬수용체 자가항체 농도는 각막침범, 시신경병증 유무 및 갑상샘눈병증 활성도/중증도와 관련하여 임상증상과 유의한 상관관계가 있음을 보여주었다. Purpose: To study the relationship between the levels of serum thyroid-stimulating hormone (TSH)-receptor autoantibodies (TRAbs) and thyroid eye disease (TED) activity and severity scores. Methods: A cross-sectional study was performed. The medical records of 315 patients diagnosed with TED between March 2014 and December 2019 were reviewed. The clinical activity score (CAS) was used to assess TED activity and a modified NOSPECS score was used for severity grading. The serum TRAb level was measured using two assays: a TSHR binding inhibitory immunoglobulin (TBII) assay and thyroid stimulating immunoglobulin (TSI) bioassay. Results: The TBII and TSI assay results were significantly positively correlated with the CAS (R = 0.113 and 0.211, respectively; p < 0.05), modified NOSPECS score (R = 0.173 and 0.316, respectively; p < 0.05), and proptosis (R = 0.136 and 0.167, respectively; p < 0.05). Both assays demonstrated significant differences in the level of TRAb between patients with and without compressive optic neuropathy or corneal epithelial defects. Conclusions: The levels of TRAbs according to both TBII and TSI assays showed significant correlations with clinical signs of corneal involvement, optic neuropathy, and TED activity and severity.

갑상샘눈병증에서 갑상샘자극항체 수치 변화에 따른 외안근 두께 변화의 상관관계 분석

곽지영(Jeeyoung Kwak),이동철(Dong Cheol Lee) 대한안과학회 2021 대한안과학회지 Vol.62 No.10

목적: 갑상샘눈병증 환자에서 갑상샘자극항체(TSAb) 수치의 변화에 따른 외안근 두께의 변화를 분석하여, 그 상관성을 밝히고자 한다. 대상과 방법: 갑상샘눈병증을 진단받은 67명을 대상으로 첫 내원 시의 TSAb를 기준으로 임상적으로 유의미한 TSAb 값이 140 IU/L 이상인 실험군과, TSAb 140 IU/L 미만인 대조군으로 나누었다. 실험군과 대조군의 외안근(내직근, 외직근, 상직근, 하직근)의 두께를 전안부빛간섭단층촬영을 이용하여 측정하였다. 외안근 두께 측정 시 양안의 평균수치를 기록하였고, 힘줄의 부착부로부터 근육으로 가면서 얇아지는 가장 끝지점 부분을 수직으로 측정하였을 때의 두께를 기준으로 하였다. 첫 방문 시와 두 번째 방문 시의 TSAb와 외안근 두께를 측정하여 각 변화량 사이의 상관관계를 알아보았다. 결과: 실험군의 첫 방문에서 TSAb와 하직근의 두께가 임상적으로 유의미한 양의 상관관계를 나타냈으나(p=0.045, r=0.478), 내직근, 상직근, 외직근에서는 뚜렷한 상관관계가 보이지 않았다. 실험군에서 TSAb의 변화량에 따른 근육두께의 변화량을 보았을 때, TSAb의 변화량과 외직근 변화량은 음의 상관관계를 나타냈으며 이는 통계적으로 유의하였다(p=0.038, r=-0.357). 상직근과는 음의 경향성을 나타냈으나, 통계적으로 유의하지는 않았고(p=0.146, r=-0.669), 나머지 두 근육의 변화량에서는 어떤 경향성도 보이지 않았다. 결론: 갑상샘눈병증에서 TSAb의 변화는 안와조직 부종의 변화에 영향을 미치는 것으로 생각되며 특히 외직근의 두께 변화와 관계가 있다. Purpose: To investigate the changes in extraocular muscle thicknesses by variations in the thyroid stimulating antibody (TSAb) level in patients with thyroid eye disease (TED). Methods: A total of 67 TED patients were enrolled. They were divided into two groups: an experimental group with clinically significant elevated TSAb levels (≥140 IU/L) and a control group (TSAb <140 IU/L). All of the lateral, medial, superior, and inferior rectus muscle thicknesses were measured with the aid of anterior segment optical coherence tomography (OCT). The average thicknesses for both eyes were recorded for each patient based on the values measured at the ends of the muscles (which become vertically thinner from the points of tendon attachment). We measured changes in TSAb levels and extraocular muscle thicknesses after two follow-up periods and sought correlations among these parameters. Results: At the initial visits, the inferior rectus muscle thickness was positively correlated with the TSAb level in the experimental group (p = 0.045, r = 0.478). None of the medial, superior, or lateral rectus muscle thicknesses were so correlated. On follow-up, the variation in TSAb level correlated negatively with changes in lateral rectus muscle thickness (p = 0.038, r = -0.357). The superior rectus muscle thickness tended to be negatively correlated with the TSAb level, but statistical significance was not attained (p = 0.146, r = -0.669). The thicknesses of the inferior and superior rectus muscles did not change over time. Conclusions: In TED patients, TSAb variations seem to reflect the extent of periorbital tissue edema, thus correlating negatively with especially lateral rectus muscle thickness changes. J Korean Ophthalmol Soc 2021;62(10):1315-1323

갑상샘눈병증에서 갑상샘자극호르몬수용체 자가항체가 망막 및 맥락막혈관에 미치는 영향

박지웅,김유철,이동철 대한안과학회 2020 대한안과학회지 Vol.61 No.10

Purpose: We describe the use of optical coherence tomography angiography (OCTA) to investigate the relationship between thyroid-stimulating hormone receptor autoantibody (TSHR Ab) levels and retinal vessel and choroid changes in patients with thyroid eye disease (TED). Methods: We enrolled 23 TED patients with abnormal TSHR Ab levels (>1.5 IU/L; all right eyes). Sex, visual acuity, intraocular pressure and TSHR Ab level were recorded at baseline and after 1 month. We used OCTA to determine the size of the superficial and deep foveal avascular zones (sFAZ and dFAZ, respectively), as well as the 1-mm foveal and 3-mm parafoveal superficial capillary plexus density (sCPD) and choroidal thickness (CT), at baseline and after 1 month later. Results: The mean age of the 23 patients was 43.30 ± 16.16 years and 18 were female (78%). The mean baseline TSHR Ab level was 11.47 ± 11.22 IU/L. The TSHR Ab level showed non-significant correlations with sFAZ and dFAZ size, and with the 1-mm foveal sCPD; the correlation coefficients were 0.173, 0.073, and 0.266, respectively (p = 0.465, p = 0.759, and p = 0.224, respectively). The 3-mm parafoveal sCPD and CT showed non-significant correlations with the TSHR Ab level; the correlation coefficients were -0.185 and -0.16 (p = 0.421, p = 0.487). Conclusions: In TED patients, changes in TSHR Ab level over 1 month do not affect retinal blood flow or CT, but show a non-significant positive association with the 1-mm foveal sCPD. 목적: 갑상샘눈병증(thyroid eye disease, TED) 환자에서 빛간섭단층촬영혈관조영술(optical coherence tomography angiography, OCTA)을 이용하여 갑상샘자극호르몬수용체 자가항체(thyroid stimulating hormone receptor antibody, TSHR Ab)의 변화와 망막혈관 및 맥락막의 변화의 연관성을 알아보고자 하였다. 대상과 방법: TED로 진단받은 환자 중 TSHR Ab 이상(>1.5 IU/L)을 보인 환자군 23명(우안)을 대상으로 망막의 표층부 무혈관 부위(superficial foveal avascular zone, sFAZ) 및 심층부 무혈관 부위(deep foveal avascular zone, dFAZ) 크기, 황반부중심의 지름1 mm 중심와, 3 mm 중심와부근 영역의 표층모세혈관총밀도(superficial capillary plexus density, sCPD) 및 맥락막두께(choroidal thickness, CT)를 측정하였고 내원 1개월 이후 반복 시행하여 TSHR Ab 변화에 대한 상관관계를 분석하였다. 결과: sFAZ, dFAZ, 1 mm 중심와 sCPD에서 양의 경향성을 보였으나(p=0.465, p=0.759, p=0.224), 3 mm 중심와부근 sCPD와 CT에서는 음의 경향성을 보이며, 모든 변수에 통계적인 유의성은 없었다(p=0.421, p=0.487). 결론: TED 환자에서 1개월 간의 TSHR Ab의 변화량에 따라 망막혈류와 맥락막두께 변화량에는 영향이 없으나, 1 mm 중심와 sCPD에서는 강한 양의 경향성을 가진다.

갑상선 안병증 환자에서 점안 마취하 수술 중 조정사시수술의 효과와 예후 인자에 대한 평가

박현주,이종복,윤진숙,유수리나 대한안과학회 2015 대한안과학회지 Vol.56 No.4

목적: 갑상선 안병증에서 점안 마취하 수술 중 조정 사시수술의 효과와 예후 인자에 대해 분석하고자 한다. 대상과 방법: 2005년부터 2012년까지 갑상선 안병증으로 인한 사시로 수술 중 조정 사시수술을 시행 받은 30명의 의무기록을 후향적으로 조사하였다. 성공적인 수술은 술 후 1년째 평가에서 남은 사시각이 8 프리즘 디옵터 이내이며 제일 눈위치에서 복시가 없는것으로 정의하였다. 수술 성공과 실패의 두 군 간 유의한 차이를 보인 인자들에 대해 비교하였다. 결과: 수술 전 평균 수직 사시는 17.5 프리즘 디옵터였고, 수평 사시는 20.3 프리즘 디옵터였다. 평균 추적관찰 기간은 12.4개월이었다.총 30명 중 24명(80.0 %)이 성공적인 수술 결과를 보였다. 4명(13.3 %)은 사시의 재발로 인해 추가적 수술이 필요했고, 2명(6.7 %)은수술 후 남은 사시를 교정하기 위해 프리즘 안경의 착용이 필요했다. 안구돌출(p=0.02) 혹은 시신경병증(p=0.01)의 합병, 스테로이드정맥 주사술 기왕력(p=0.02), 고용량 스테로이드 정맥 주사술을 시행 받은 횟수(p=0.01), 그리고 안와 감압술 기왕력(p=0.03)이 수술성공과 실패의 두 군 사이에서 유의한 차이를 보였다. 결론: 갑상선 안병증에서 안구돌출이나 시신경병증, 스테로이드 정맥 주사술 기왕력, 그리고 안와 감압술 기왕력과 같은 더 진행된 임상 양상을 반영하는 인자를 가진 환자들에서 사시 수술의 성공률이 더 낮았다. 또한 저자들은 점안 마취하 수술 중 조정 사시수술을 시행하여 80.0%의 성공적인 결과를 얻었다. Purpose: To evaluate the prognostic factors that contribute to favorable surgical outcomes of single-stage adjustable strabismus surgery in thyroid eye disease. Methods: Retrospective review of clinical case notes were done of all patients who had surgical treatment for strabismus related to thyroid eye disease under the care of a single hospital between January 2005 and December 2012 (n = 30). Factors that possibly influenced the outcome were statistically analyzed for significance. “Successful” surgical outcome was defined as patients whose residual deviation was within 8 prism diopters and free from diplopia in the primary position on postoperative 1 year. Results: Mean preoperative vertical deviation was 17.5 prism diopters (PD) and horizontal deviation was 20.3 PD. Mean follow-up time was 12.4 months. Twenty-four patients (80.0%) had successful surgical results. Four patients (13.3%) needed further surgery due to recurrence of previous strabismus and two patients (6.7%) needed prism glasses due to remaining strabismus. Previous history of proptosis (p = 0.02), optic neuropathy (p = 0.01), intravenous (IV) steroid pulse therapy (p = 0.02),number of times of IV steroid pulse therapy (p = 0.01), and orbital decompression surgery (p = 0.03) were different between success and failure groups. Conclusions: Single-stage adjustable strabismus surgery under topical anesthesia showed a success rate of 80% for strabismus patients with thyroid eye disease. Patients who previously had proptosis, optic neuropathy, IV steroid pulse therapy, and orbital decompression surgery significantly showed unsuccessful results after strabismus surgery.

갑상샘눈병증 환자에서 고용량 스테로이드 주사 치료 후 임상 양상 및 자가항체 수치 변화

정지현(Jee Hyun Jeong),이동철(Dong Cheol Lee) 대한안과학회 2024 대한안과학회지 Vol.65 No.6

목적: 고용량 스테로이드 주사 후 임상 활동도 점수(clinical activity score, CAS), 안구돌출도, 눈꺼풀각막반사간거리1 (margin-reflex distance 1, MRD1), 자가항체 수치 변화를 확인하고자 하였다. 대상과 방법: 갑상샘눈병증 진단 후 고용량 정맥 스테로이드 주사한 83명의 환자에 대해 후향적 연구가 이루어졌다. 안구돌출도, MRD1, CAS, 갑상샘자극항체(thyroid-stimulating antibody, TSAb), 갑상샘자극호르몬수용체항체(thyroid-stimulating hormone receptor antibody, TSHR Ab)는 치료 시작 전 기저 수치, 치료 시작 6주, 12주 후, 치료 종료 2개월 후 평가되었다. 또한 기저 혈청 셀레늄수치가 치료 예후와의 관계를 확인하기 위해 평가되었다. 결과: TSAb, TSHRAb 그리고 CAS는 치료 종료 2개월 후까지 지속적인 감소를 보였으며, 각각 443.2 specimen-to-reference control ratio (SRR%)에서 341.03 SRR%, 22.18 IU/L에서 7.91 IU/L, 3.37에서 1.88 (p<0.0001)로 나타났다. 안구돌출도는 기저 수치와비교하여 유의미한 효과를 보이는 시점은 없었으며, MRD1은 치료 시작 12주째 감소를 보였으나, 치료 종료 2개월 후에는 차이가 확인되지 않았다. 기저 혈청 셀레늄 수치와 안구돌출도, MRD1, TSAb, TSHR Ab, CAS의 변화 간 상관관계는 보이지 않았다. 결론: 고용량 정맥 스테로이드 치료는 TSAb, TSHR Ab 및 CAS의 개선에 있어 효과적이며 치료 종료 2개월째까지도 지속된 효과를보여준다. 하지만 눈꺼풀뒤당김 및 안구돌출도의 완화 측면에 있어서는 한계가 확인되며, 기저 셀레늄 수치는 임상 양상 변화와 상관관계를 보이지 않았다. Purpose: To evaluate the effects of intravenous steroid therapy on the clinical activity score (CAS), exophthalmos, margin-reflex distance 1 (MRD1), and autoantibody levels in patients with thyroid eye disease. Methods: In this retrospective observational study, we enrolled 83 patients diagnosed with thyroid eye disease treated with intravenous steroid therapy. We assessed exophthalmos, MRD1, CAS, thyroid-stimulating antibody (TSAb), and thyroid-stimulating hormone receptor antibody (TSHR Ab) levels at baseline, 6 and 12 weeks after initiating therapy, and 2 months after therapy termination. Additionally, baseline serum selenium levels were examined to determine their impact on treatment efficacy. Results: TSAb, TSHRAb, and CAS levels showed a continuous decline from 443.22 to 341.03 specimen-to-reference control ratio (SRR%), 22.18 to 7.91 IU/L, and 3.37 to 1.88, respectively (p < 0.0001), up to 2 months following therapy termination. Exophthalmos did not show significant changes at any assessed time point up to 2 months after therapy termination. MRD1 decreased until 12 weeks after therapy initiation but showed no significant change 2 months later. No correlation was found between baseline serum selenium levels and changes in exophthalmos, MRD1, TSAb, TSHR Ab, or CAS. Conclusions: Intravenous steroid therapy was effective in reducing TSAb, TSHR Ab, and CAS levels up to 2 months after therapy termination. However, it had limited positive impact on exophthalmos or eyelid retraction. Baseline selenium levels did not correlate with the changes in any of the examined parameters.

갑상샘눈병증과 연관된 사시의 안정성과 갑상샘자극호르몬 결합억제 면역글로불린과의 연관성

황재율,성재연,김민수,이연희 대한안과학회 2023 대한안과학회지 Vol.64 No.9

Purpose: To investigate the relationship between thyrotropin binding inhibitory immunoglobulin (TBII) and deviation angle stability in strabismus-associated thyroid eye disease. Methods: A total of 25 strabismus-associated thyroid eye disease patients who were followed up for > 6 months without surgery were enrolled. To investigate the correlation between TBII levels and changes in the deviation angle, a test period of 6 months from the date of TBII measurement was established and 55 test units of the corresponding TBII levels were obtained. Results: The deviation angle had a positive correlation with the TBII levels (r = 0.473, p < 0.001), but did not correlate with sex, age, and thyroid hormone levels. Changes in the horizontal, vertical, and total deviation angles were significantly greater in the high-TBII test units compared to the normal-TBII test units (p = 0.029, = 0.032, and = 0.009, respectively). Conclusions: TBII levels were related to deviation angle stability in strabismus-associated thyroid eye disease. TBII may be a useful indicator for deviation angle stability in these patients over a period of 6 months.