Ocular Surface Changes in Treatment-Naive Thyroid Eye Disease

Abstract

Objective: To investigate the association of meibomian gland dysfunction (MGD) and ocular surface exposure with tear film instability in untreated thyroid eye disease (TED) patients. Methods: A cross-sectional study of TED patients from September 2020 to September 2022 was conducted. Ocular surface parameters included ocular surface disease index (OSDI), tear meniscus height (TMH), non-invasive tear break-up time (NITBUT), partial blinking rate, lipid layer thickness (LLT), meibomian gland dropout (meiboscore), Schirmer’s test, and corneal punctate epithelial erosions (PEE). Ocular surface exposure was assessed by the margin reflex distances of the upper and lower eyelid (MRD1 and MRD2), the amount of exophthalmos, lateral flare, and lagophthalmos. Results: In total, 152 eyes from 76 TED patients (64 females and 12 males, age 42.99 ± 12.28 years) and 93 eyes from 61 healthy controls (51 females and 10 males, age 43.52 ± 17.93 years) were examined. Compared with control eyes, TED eyes had higher OSDI, TMH, LLT, and PEE; shorter NITBUT; and worse meiboscore (all p < 0.05). They also had larger amounts of exophthalmos, longer MRD1, more lateral flare, and lagophthalmos. Multivariate analysis identified an association of the tear film instability with lagophthalmos (β = −1.13, 95%CI: −2.08, −0.18) and severe MGD in the lower eyelid (β = −5.01, 95%CI = −7.59, −2.43). Conclusions: Dry eye in TED is mainly manifested as evaporative dry eye disease. Severe lower eyelid MGD and worse lagophthalmos were significantly associated with tear film instability in treatment-naive TED patients.

Ocular surface and meibomian gland evaluation in euthyroid Graves’ ophthalmopathy

“… 36 Recently, we found occurrence of evaporative dry eye disease in Chinese TED patients. 37 Huang et al investigated the tear samples of Chinese TED patients and found the concentration of interleukin 1β, 6, and 8 was found higher in TED patients than controls, and TED patients were associated with a short tear break-up time and Schirmer test. 14 On the contrary, the Chinese EGO patients in our study did not show any difference in tear meniscus height noninvasive tear break-up time and Schirmer tear, clearly indicating absence of aqueous deficient component in EGO eyes.…”

“…The absence of aqueous deficiency in our study indicates a specific pattern of ocular adnexal targets between TED and EGO patients. 37 …”