{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T08:42:27Z","timestamp":1788856947665,"version":"build-2803163510"},"reference-count":36,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: To investigate the scleral inferior rectus\u2013optic nerve distance (SIROND) and its association with intraocular pressure (IOP) elevation during upward gaze in patients with thyroid eye disease (TED), based on magnetic resonance imaging (MRI) examinations. Methods: This prospective study included 20 eyes (13 patients) diagnosed with active TED. All patients underwent orbital MRI in both primary and upward gaze positions before and 6 months after steroid pulse therapy. The SIROND was measured on MRI. IOP was recorded in both gazes. Changes in SIROND, inferior rectus (IR) muscle volume, proptosis, optic disc and scleral morphology, and IOP were analyzed pre- and post-treatment. Results: SIROND significantly decreased from primary gaze to upward gaze both before and after treatment (p &lt; 0.001). Following steroid pulse therapy, there were significant reductions in IR muscle volume and proptosis (p &lt; 0.05). Correspondingly, SIROND significantly increased in both primary and more in upward gaze post-treatment (p &lt; 0.05). Although IOP during upward gaze was significantly higher than that in primary gaze both before and after treatment (p &lt; 0.001), the gaze-related difference in IOP (p = 0.059), as well as SIROND, tended to be smaller after treatment (p &lt; 0.001). A larger reduction in gaze-related pre-treatment SIROND was associated with greater IOP elevation in upward gaze (p = 0.038). MRI showed no evidence of globe compression by the IR muscle, and optic disc morphology remained unchanged following treatment. Conclusions: SIROND may serve as supportive radiological evidence for IOP elevation induced by upward gaze in patients with TED.<\/jats:p>","DOI":"10.3390\/diagnostics16101521","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T08:56:27Z","timestamp":1779094587000},"page":"1521","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A Pilot MRI Study of Upward Gaze-Induced Intraocular Pressure Elevation in Thyroid Eye Disease"],"prefix":"10.3390","volume":"16","author":[{"given":"Muhammad","family":"Abumanhal","sequence":"first","affiliation":[{"name":"Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Nagakute 480-1195, Aichi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chrisha Faye","family":"Habaluyas","sequence":"additional","affiliation":[{"name":"Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Nagakute 480-1195, Aichi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naomi","family":"Umezawa","sequence":"additional","affiliation":[{"name":"Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Nagakute 480-1195, Aichi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1363-2870","authenticated-orcid":false,"given":"Yasuhiro","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Nagakute 480-1195, Aichi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,18]]},"reference":[{"key":"ref_1","first-page":"101464","article-title":"A randomised, double-masked, placebo-controlled trial evaluating the efficacy and safety of teprotumumab for active thyroid eye disease in Japanese patients","volume":"55","author":"Hiromatsu","year":"2025","journal-title":"Lancet Reg. Health West. Pac."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1016\/j.autrev.2014.01.013","article-title":"Diagnosis and classification of Graves\u2019 disease","volume":"13","author":"Menconi","year":"2014","journal-title":"Autoimmun. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1038\/s41433-018-0302-1","article-title":"Clinical pathophysiology of thyroid eye disease: The Cone Model","volume":"33","author":"Meyer","year":"2019","journal-title":"Eye"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Luccas, R., Riguetto, C.M., Alves, M., Zantut-Wittmann, D.E., and Reis, F. (2024). Computed tomography and magnetic resonance imaging approaches to Graves\u2019 ophthalmopathy: A narrative review. Front. Endocrinol., 14.","DOI":"10.3389\/fendo.2023.1277961"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Song, Y., Li, T., Tang, W., Lv, Q., Zhang, X.X., Zhou, W.Y., and Shi, Y.Q. (2025). Application progress of magnetic resonance imaging in thyroid associated ophthalmopathy. Front. Endocrinol., 16.","DOI":"10.3389\/fendo.2025.1537957"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1016\/S0161-6420(97)30207-3","article-title":"The prevalence and implications of ocular hypertension and glaucoma in thyroid-associated orbitopathy","volume":"104","author":"Cockerham","year":"1997","journal-title":"Ophthalmology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1491","DOI":"10.1016\/S0161-6420(91)32100-6","article-title":"The role of increased intraocular pressure on upgaze in the assessment of Graves ophthalmopathy","volume":"98","author":"Spierer","year":"1991","journal-title":"Ophthalmology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"229\u2013233","DOI":"10.1001\/archotol.1993.01880140119019","article-title":"Orbital decompression for preservation of vision in Graves\u2019 ophthalmopathy","volume":"119","author":"Girod","year":"1993","journal-title":"Arch. Otolaryngol. Head. Neck Surg."},{"key":"ref_9","first-page":"284\u2013290","article-title":"Clinical manifestations and treatment outcome of optic neuropathy in thyroid-related orbitopathy","volume":"37","author":"Syed","year":"2006","journal-title":"Ophthalmic Surg. Lasers Imaging"},{"key":"ref_10","first-page":"145\u2013150","article-title":"Intraocular pressure changes after treatment for Graves\u2019 orbitopathy","volume":"108","author":"Savino","year":"2001","journal-title":"Ophthalmology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"666\u2013672","DOI":"10.3109\/02713683.2013.867355","article-title":"Intraocular pressure lowering effect of orbital decompression is related to increased venous outflow in Graves orbitopathy","volume":"39","author":"Onaran","year":"2014","journal-title":"Curr. Eye Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"535\u2013543","DOI":"10.1038\/eye.2011.362","article-title":"The effect of orbital decompression surgery on refraction and intraocular pressure in patients with thyroid orbitopathy","volume":"26","author":"Norris","year":"2012","journal-title":"Eye"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1097\/IOP.0000000000000007","article-title":"Intraocular pressure change with eye positions before and after orbital decompression for thyroid eye disease","volume":"30","author":"Takahashi","year":"2014","journal-title":"Ophthalmic Plast. Reconstr. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1327","DOI":"10.6061\/clinics\/2012(11)18","article-title":"Imaging studies for diagnosing Graves\u2019 orbitopathy and dysthyroid optic neuropathy","volume":"67","author":"Gebrim","year":"2012","journal-title":"Clinics"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"9736247","DOI":"10.1155\/2021\/9736247","article-title":"The effect of inferior rectus muscle thickening on intraocular pressure in thyroid-associated ophthalmopathy","volume":"2021","author":"Li","year":"2021","journal-title":"J. Ophthalmol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1016\/j.survophthal.2009.02.023","article-title":"Intraocular pressure change in orbital disease","volume":"54","author":"Nassr","year":"2009","journal-title":"Surv. Ophthalmol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1080\/08820538.2023.2166354","article-title":"Secondary effects of orbital decompression in thyroid eye disease: A review","volume":"38","author":"Takahashi","year":"2023","journal-title":"Semin. Ophthalmol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1167\/iovs.64.10.31","article-title":"The changes in ocular biomechanical response parameters and intraocular pressure after surgical treatment for thyroid eye disease","volume":"64","author":"Hsia","year":"2023","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1097\/IJG.0000000000000942","article-title":"Prevalence of ocular hypertension and glaucoma as well as associated factors in Graves\u2019 orbitopathy","volume":"27","author":"Kim","year":"2018","journal-title":"J. Glaucoma"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1016\/S0002-9394(14)72787-4","article-title":"Diagnostic criteria for Graves\u2019 ophthalmopathy","volume":"119","author":"Bartley","year":"1995","journal-title":"Am. J. Ophthalmol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1007\/s00417-022-05827-y","article-title":"Risk factors for development of superior limbic keratoconjunctivitis in thyroid eye disease in Japanese","volume":"261","author":"Takahashi","year":"2023","journal-title":"Graefes Arch. Clin. Exp. Ophthalmol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"112644","DOI":"10.1016\/j.ejrad.2025.112644","article-title":"Research progress and clinical utility of multi-parameter orbital MRI in thyroid-associated ophthalmopathy","volume":"195","author":"Gou","year":"2026","journal-title":"Eur. J. Radiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1002\/jmri.29114","article-title":"Application of Quantitative MRI in Thyroid Eye Disease: Imaging Techniques and Clinical Practices","volume":"60","author":"Zhang","year":"2024","journal-title":"J. Magn. Reson. Imaging."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Cai, M., Yang, J., Li, X., Hu, Y., Liao, H., and Xiong, C. (2025). MRI-based SIR quantitative biomarkers: A novel imaging diagnostic strategy for thyroid eye disease activity staging. Front. Endocrinol., 16.","DOI":"10.3389\/fendo.2025.1650116"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1016\/j.ophtha.2009.06.064","article-title":"Dynamic study of the medial and lateral recti capsulopalpebral fasciae using cine mode magnetic resonance imaging","volume":"117","author":"Kakizaki","year":"2010","journal-title":"Ophthalmology"},{"key":"ref_26","unstructured":"(2025, November 06). The Japanese Committee for Diagnostic Criteria and Guideline to Medical Care for Thyroid-Associated Malignant Exophthalmos. The Guideline for Treatment of Thyroid Eye Disease. Available online: http:\/\/www.japanthyroid.jp\/doctor\/img\/basedou02.pdf."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"3977","DOI":"10.1007\/s00417-022-05760-0","article-title":"Ocular hypertension in patients with active thyroid-associated orbitopathy: A predictor of disease severity, particularly of extraocular muscle enlargement","volume":"260","year":"2022","journal-title":"Graefes Arch. Clin. Exp. Ophthalmol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1007\/s00441-013-1596-8","article-title":"Glaucoma and optic nerve repair","volume":"353","author":"Diekmann","year":"2013","journal-title":"Cell Tissue Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"325","DOI":"10.4103\/tjo.tjo_30_22","article-title":"Effect of teprotumumab on intraocular pressure in thyroid-associated ophthalmopathy","volume":"12","author":"Adetunji","year":"2022","journal-title":"Taiwan J. Ophthalmol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1136\/bjophthalmol-2020-317806","article-title":"Teprotumumab reduces extraocular muscle and orbital fat volume in thyroid eye disease","volume":"106","author":"Jain","year":"2022","journal-title":"Br. J. Ophthalmol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1097\/IOP.0000000000002867","article-title":"Clinical and radiologic predictors of response to teprutoumumab: A 3D volumetric analysis of 35 patients","volume":"41","author":"Ugradar","year":"2025","journal-title":"Ophthalmic Plast. Reconstr. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1080\/01676830.2025.2574861","article-title":"Differential change in extraocular muscle volume after teprotumumab for thyroid eye disease","volume":"45","author":"Richkind","year":"2026","journal-title":"Orbit"},{"key":"ref_33","unstructured":"Kozaki, A., Takahashi, Y., Tajiri, Y., Wang, Z., Hayashida, T., Kumar, A., Hiromatsu, Y., and Mimura, M. (2026). Reduction in extraocular muscle and orbital fat volumes after teprotumumab treatment in Japanese patients with thyroid eye disease: An exploratory magnetic resonance imaging analysis from the OPTIC-J trial. Jpn. J. Ophthalmol., in press."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1001\/jamaophthalmol.2021.6284","article-title":"Proptosis and diplopia response with teprotumumab and placebo vs the recommended treatment regimen with intravenous methylprednisolone in moderate to severe thyroid eye disease: A meta-analysis and matching-adjusted indirect comparison","volume":"140","author":"Douglas","year":"2022","journal-title":"JAMA Ophthalmol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2349","DOI":"10.1007\/s00417-025-06855-0","article-title":"Time to improvement following teprotumumab treatment of thyroid eye disease: Real world experience","volume":"263","author":"Yagoda","year":"2025","journal-title":"Graefes Arch. Clin. Exp. Ophthalmol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1097\/IJG.0b013e3181ca7ca5","article-title":"IOP variations in the sitting and supine positions","volume":"19","author":"Jorge","year":"2010","journal-title":"J. Glaucoma"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/10\/1521\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T09:34:34Z","timestamp":1779096874000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/10\/1521"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,18]]},"references-count":36,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["diagnostics16101521"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16101521","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,18]]}}}