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Impact of Graves’ Disease on Ocular Surface and Corneal Epithelial Thickness in patients with and without Graves’ Orbitopathy

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First Author: A.Carreira PORTUGAL

Co Author(s):    F. Moraes   T. Loureiro   S. Rodrigues-Barros   P. Campos   J. Cardoso   N. Campos     

Abstract Details

Purpose:

Thyroid eye disease has been associated to dry eye. Our aim was to assess ocular tear film and corneal epithelial thickness (CET) in patients with Graves’ Disease (GD) with and without Graves’ Orbitopathy (GO).

Setting:

Garcia de Orta Hospital, Almada, Portugal.

Methods:

This study included patients with GD with and without GO (Group 1) and healthy age-matched controls (Group 2). GO was diagnosed according to the criteria of the European Group on Graves’ Orbitopathy and disease activity was assessed by Clinical Activity Score (CAS). Patients underwent an evaluation of symptoms (Ocular Surface Disease Index (OSDI) questionnaire), assessment of corneal epithelial thickness map (by anterior segment optical coherence tomography using the Zeiss Cirrus HD-5000 device), Schirmer test and tear break-up time test (BUT), with a 15-minute gap between the implemented tests. Measurements between groups and GD’s subgroups were compared.

Results:

Thirty-four eyes were included in Group 1 (18 with GO and 16 without) and 24 in Group 2, with a mean age of 45.06±12.32 and 41.00±13.65 years, respectively. All patients with GO had inactive disease (mean CAS: 1.33±0.69). Group 1 had lower BUT (mean 6.76±2.84 vs 11.63±2.18s; p0.001) and higher OSDI scores (mean 15.26±2.89 vs 9.88±2.35; p0.001). Superior CET in the 2-5mm zone was lower in Group 1 (mean 50.12±5.26 vs 56.40±2.27µm; p=0.04). Among patients with GD, no differences were found between patients with and without GO (p0.05). There was a correlation between BUT and CET (superior sector: p=0.03, r=0.312).

Conclusions:

Increased ocular globe exposure due to proptosis and eyelid retraction has been pointed out as a major contributing factor to dry eye disease in patients with GD. In our study, GD had a negative impact on ocular surface and corneal thickness, with a higher level of eye dryness and corneal thinning regardless of GO. This finding suggests that subclinical chronic ocular inflammation may also play a role in the pathogenesis of tear film evaporation and corneal thinning.

Financial Disclosure:

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