Ankara Atatürk Training and Research Hospital, 2nd Ophthalmology Department, Ankara, Turkey.
Curr Eye Res. 2011 Jan;36(1):8-13. doi: 10.3109/02713683.2010.526285.
To evaluate the tear function tests and the ocular surface damage in Graves' disease (GD) patients either with or without thyroid associated orbitopathy (TAO).
Forty-two eyes of 21 randomly selected patients with GD, and 30 eyes of 15 healthy subjects were included in this prospective study. The presence of TAO was evaluated clinically. The palpebral fissure height, degree of proptosis, ocular surface disease index (OSDI), Schirmer tear test, tear break-up time (TBUT), and conjunctival impression cytology were assessed. The results were first compared between the patient and the control groups. Results were then compared between the patients with TAO (group I) and without TAO (group II).
The mean OSDI score in the patient group was 44.79 ± 11.83 and it was 21.17 ± 9.89 in the control group (p = 0.001). The mean Schirmer tear test score was 14.4 ± 8.32 mm and 24.9 ± 3.57 mm in the patient and control group, respectively (p = 0.001). The mean TBUT in the patient group was 7.1 sec. In the control group it was significantly increased to 10 sec (p = 0.003). The mean proptosis and interpalpebral distance did not show any difference between the GD patients and controls (p > 0.05). The patients with GD showed significant ocular surface damage in which 75.71% had grade 2-3 squamous metaplasia in temporal interpalpebral conjunctiva. Twenty-four (57%) eyes composed group I. There were no differences in the mean OSDI score, Schirmer tear test score, TBUT, and the amount of ocular surface damage between group I and group II (p > 0.05).
Dry eye findings and the ocular surface damage in GD were most likely associated with the ocular surface inflammation. Before the development of the classic findings of TAO, ocular surface inflammation can be the only presenting clinical sign in GD.
评估格雷夫斯病（GD）患者伴或不伴甲状腺相关眼病（TAO）的泪液功能测试和眼表损伤。
本前瞻性研究纳入了 21 例随机选择的 GD 患者的 42 只眼，以及 15 例健康受试者的 30 只眼。临床评估 TAO 的存在。评估了睑裂高度、眼球突出度、眼表疾病指数（OSDI）、泪液分泌试验、泪膜破裂时间（TBUT）和结膜印迹细胞学。首先将患者组和对照组的结果进行比较。然后比较 TAO 患者（组 I）和无 TAO 患者（组 II）的结果。
患者组的平均 OSDI 评分为 44.79±11.83，对照组为 21.17±9.89（p=0.001）。患者组的平均 Schirmer 泪液测试评分为 14.4±8.32mm，对照组为 24.9±3.57mm（p=0.001）。患者组的平均 TBUT 为 7.1 秒，对照组显著增加至 10 秒（p=0.003）。GD 患者的平均眼球突出度和睑裂宽度与对照组之间无差异（p>0.05）。GD 患者表现出明显的眼表损伤，其中 75.71%的患者颞侧睑间结膜出现 2-3 级鳞状化生。24 只（57%）眼组成组 I。组 I 和组 II 之间的平均 OSDI 评分、Schirmer 泪液测试评分、TBUT 和眼表损伤程度无差异（p>0.05）。
GD 中的干眼发现和眼表损伤很可能与眼表炎症有关。在 TAO 的典型表现出现之前，眼表炎症可能是 GD 的唯一临床表现。
