AIM: To identify differences in clinical features between thyroid eye disease (TED) patients with and without strabismus. METHODS: This retrospective, single-center, consecutive case series study was conducted on TED patients who were determined to be surgical candidates. The patients’ cohort were divided into two groups based on the presence or absence of strabismus. Demographics and complete eye examinations were recorded and compared between the TED and TED with strabismus groups. RESULTS: A total of 76 patients with TED were enrolled, including 58 males (76.3%) with a mean age of 52.68±10.45y. The 55 patients (male:female=2:1) were found to have TED with strabismus, while the remaining 21 patients (male:female=4:1) had TED without strabismus. There was nearly a four times greater likelihood of lid retraction being associated with TED without strabismus (OR=4.1, P=0.018) and they showed higher prevalence of proptosis (95.2%) than the TED strabismus group (63.6%, P<0.001). In the TED-strabismus group, 20% of patients had abnormal head posture (AHP), while none were identified in the TED group (P=0.029). Despite the higher incidence of vision-threatening complications such as dysthyroid optic neuropathy (19% vs 8.1%) and exposure keratopathy (4.8% vs 1.8%) in the TED group than in the TED-strabismus group, the difference did not reach statistical significance (P>0.05). The most common types of strabismus were hypotropia (36%) and esotropia (29%), respectively. CONCLUSION: Strabismus-associated TED is characterized by a lower prevalence of proptosis and lid retraction, but a higher incidence of compensatory AHP. Identifying these differences may aid in risk stratification and early intervention for TED patients, particularly those at risk for restrictive strabismus.