Dry eye in Graves ophthalmopathy: correlation with corneal hypoesthesia

To evaluate dry eye disease and corneal sensitivity in patients with early and active Graves ophthalmopathy (GO).

A total of 52 eyes of 26 patients with early GO and 74 eyes of 37 age- and sex-matched controls were included in our study. Dry eye disease was assessed based on the criteria of the 
International Dry Eye Workshop. Diagnosis of early GO was based on the European Group on Graves' Orbitopathy consensus statement. Clinical Activity Score (CAS) and Werner-NOSPECS Score were determined. Corneal sensitivity was assessed using a Cochet-Bonnet aesthesiometer.

A total of 67.8% of patients with early GO and 13.5% of healthy controls had ocular surface dryness (p<0.001). The mean Schirmer test score was significantly lower in patients with early GO (12.88 ± 7.94 mm [right eyes] and 14.04 ± 9.00 mm [left eyes]) than in controls (18.08 ± 7.26 mm [right eyes] and 18.05 ± 7.50 mm [left eyes] [p<0.05]). The tear film break-up time was lower in patients by 5.46 seconds and 5.74 seconds in right and left eyes (p<0.001). We also found a significant reduction in corneal sensitivity in patients with early GO (4.16 ± 0.68 [right eyes] and 4.10 ± 0.89 [left eyes]) than in controls (4.70 ± 0.34 [right eyes] and 4.72 ± 0.34 [left eyes] [p<0.05]). The CAS correlated significantly with the Schirmer test (r = -0.60, p = 0.003).

Dry eye is common in early GO even in the absence of apparent exophthalmos and is associated with CAS and reduced corneal sensitivity.