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Ocular Surface Changes in Treatment-Naive Thyroid Eye Disease.

Xulin Liao1, Kenneth Ka Hei Lai1,2, Fatema Mohamed Ali Abdulla Aljufairi1,3

  • 1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China.

Journal of Clinical Medicine
|May 13, 2023
PubMed
Summary

Tear film instability in untreated thyroid eye disease (TED) is linked to evaporative dry eye. Severe lower eyelid meibomian gland dysfunction (MGD) and lagophthalmos significantly contribute to this instability.

Keywords:
dry eyelagophthalmosmeibomian gland dysfunctionnon-invasive tear break-up timethyroid eye disease

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Area of Science:

  • Ophthalmology
  • Dry Eye Disease Research
  • Thyroid Eye Disease Management

Background:

  • Thyroid eye disease (TED) often presents with ocular surface complications, including dry eye.
  • Meibomian gland dysfunction (MGD) and ocular surface exposure are implicated in dry eye pathogenesis.
  • Understanding these associations is crucial for managing TED patients.

Purpose of the Study:

  • To investigate the relationship between meibomian gland dysfunction (MGD) and ocular surface exposure with tear film instability.
  • To identify key factors contributing to dry eye in untreated thyroid eye disease (TED) patients.

Main Methods:

  • A cross-sectional study included 76 TED patients and 61 healthy controls.
  • Ocular surface parameters (OSDI, TMH, NITBUT, LLT, meiboscore, PEE, Schirmer's test) and exposure indicators (MRD1, MRD2, exophthalmos, lateral flare, lagophthalmos) were assessed.
  • Multivariate analysis was used to determine associations.

Main Results:

  • TED patients exhibited higher OSDI, TMH, LLT, PEE, and worse meiboscore compared to controls.
  • TED eyes showed shorter NITBUT, increased exophthalmos, longer MRD1, lateral flare, and lagophthalmos.
  • Lagophthalmos and severe lower eyelid MGD were significantly associated with tear film instability.

Conclusions:

  • Dry eye in TED is predominantly evaporative.
  • Severe lower eyelid MGD and lagophthalmos are significant predictors of tear film instability in treatment-naive TED.
  • These findings highlight the importance of addressing MGD and eyelid closure in TED management.