Global Trends in Eyelid Disease associated with Thyroid Ophthalmopathy (1975-2025): A Systematic Review and Meta-Analysis

Purpose: To evaluate global trends in the prevalence, spectrum and surgical outcomes of eyelid involvement in Thyroid-Associated Ophthalmopathy (TAO) over a 50-year period (1975-2025) using a PRISMA 2020-compliant systematic review and meta-analysis. Methods: A comprehensive search of PubMed/MEDLINE, Embase, Web of Science, Scopus and the Cochrane Library was conducted for studies published between 1 January 1975 and 31 December 2025. Eligible studies reported epidemiologic, clinical or surgical outcomes of eyelid involvement in TAO. Random-effects meta-analysis (DerSimonian and Laird method) was performed to calculate pooled prevalence and surgical success rates. Heterogeneity was assessed using the I² statistic. Subgroup and meta-regression analyses evaluated temporal, geographic and economic variations. Risk of bias was assessed using the Newcastle-Ottawa Scale and Cochrane RoB 2 tool and certainty of evidence was graded using GRADE methodology. Results: A total of 655 studies were included in qualitative synthesis, with 355 studies incorporated into quantitative analysis. The pooled prevalence of eyelid involvement was 62.8% (95% CI: 59.4%-66.1%; I² = 84.6%). Upper eyelid retraction (58.7%) and eyelid edema (49.5%) were the most common manifestations, followed by dry eye disease (38.9%) and meibomian gland dysfunction (31.6%). Prevalence increased significantly across decades (β = 0.42% per year; p = 0.002). Among 311 surgical studies, pooled success was 84.3% (95% CI: 81.1%-87.2%), improving to over 90% in recent years (β = +0.31% per year; p = 0.01). No significant publication bias was detected. Conclusion: Eyelid involvement in TAO is highly prevalent and demonstrates a sustained global increase over five decades. Concurrent improvements in surgical outcomes reflect advances in diagnostic precision, multidisciplinary care and therapeutic innovation. Standardized reporting and global collaboration are essential to further optimize management strategies.