Smoking Is Associated With a Higher Risk of Surgical Intervention for Thyroid Eye Disease in the IRIS Registry

center dot PURPOSE: To describe the association of smoking status with surgical intervention for thyroid eye disease (TED) at the population-level.center dot DESIGN: Retrospective cohort study.center dot METHODS: This study included all adults (aged >18 years) with Graves disease in the Intelligent Research in Sight (IRIS) Registry (January 1, 2013, to December 31, 2020). The primary outcome was surgical intervention for TED, stratified into orbital decompression, strabismus surgery, and eyelid recession surgery. The Kaplan-Meier estimated 5-year cumulative probability for each surgical intervention was calculated. Multivariable Cox regression was used to evaluate the association between smoking sta-tus and each surgical intervention, adjusting for age, sex, race, ethnicity, and geographic region. center dot RESULTS: This study included 87,774 patients. Me-dian age was 59 years (IQR, 48-68 years); 81% were female patients. Current smokers had a greater 5-year cu-mulative probability of orbital decompression (3.7% vs 1.9%; P < .001), strabismus surgery (4.6% vs 2.2%; P < .001), and eyelid recession (4.1% vs 2.6%; P < .001) compared to never smokers. After adjusting for demo-graphic factors, current smokers were at greater risk for orbital decompression (hazard ratio [HR], 2.1; 95% CI, 1.8-2.4; P < .001), strabismus surgery (HR, 2.0; 95% CI, 1.8-2.3; P < .001), and eyelid recession (HR, 1.7; 95% CI, 1.5-1.9; P < .001) than never smokers. Former smokers were at higher risk for each type of surgery for TED, albeit at lower levels than current smokers. center dot CONCLUSIONS: Smoking was associated with increased risk of surgical intervention for TED in the IRIS Reg-istry. Former smokers were at a lower risk than current smokers, supporting the role of smoking cessation on low-ering the burden of surgical disease at the population -level. (Am J Ophthalmol 2023;249: 174-182. (c) 2023 Elsevier Inc. All rights reserved.)