Department of Ophthalmology, Korea University College of Medicine, Seoul, Korea.
Department of Ophthalmology, KEPCO Medical Center, Seoul, Korea.
Can J Ophthalmol. 2018 Aug;53(4):373-379. doi: 10.1016/j.jcjo.2017.11.006. Epub 2018 Feb 3.
The purpose of this study was to evaluate the structure and function of the meibomian gland and the incomplete blinking rate to understand the pathophysiology of dry eye in thyroid eye disease (TED) patients.
Patients who were diagnosed with TED were enrolled between October 2015 and February 2016. Clinical measurements were performed in the following order: (i) external examination (Hertel exophthalmometer and palpebral fissure height), (ii) LipiView interferometer (lipid layer thickness [LLT], incomplete blinking rate, and meibography), (iii) slit-lamp biomicroscopy (corneal surface staining, tear breakup time, meibum expression, Marx line).
Thirty eyes of 30 TED patients (male = 8; female = 22) were included in this study. The TED patient population had a mean age of 42.9 ± 11.8 years and a mean clinical activity score (CAS) of 2.33 ± 1.60. The meiboscore was 1.17 ± 0.90 in the upper eyelid and 0.70 ± 0.65 in the lower eyelid; scores were significantly higher in the upper eyelid (p < 0.001). The mean LLT was 82.43 ± 24.52 nm, and the mean incomplete blinking rate was 51.04 ± 33.62% (0-100%). CAS was the only variable that correlated with the meiboscore. There was no significant correlation between incomplete blinking and a degree of palpebral fissure height or proptosis.
Tear film instability due to increased incomplete blinking can cause dry eye in TED. In addition to the increase in CAS, meibomian gland dysfunction may also be a cause of dry eye in TED. However, further comparative studies are needed to confirm these results.
本研究旨在评估睑板腺的结构和功能以及不完全眨眼率，以了解甲状腺眼病（TED）患者干眼的病理生理学。
本研究于 2015 年 10 月至 2016 年 2 月间招募 TED 患者。临床检查按以下顺序进行：（i）外观检查（Hertel 突眼计和睑裂高度），（ii）LipiView 干涉仪（脂质层厚度[LLT]、不完全眨眼率和睑板腺照相），（iii）裂隙灯显微镜（角膜表面染色、泪膜破裂时间、睑板腺分泌物、Marx 线）。
本研究共纳入 30 只眼 30 例 TED 患者（男 8 例，女 22 例）。TED 患者的平均年龄为 42.9 ± 11.8 岁，平均临床活动评分（CAS）为 2.33 ± 1.60。上睑的睑板腺评分（meiboscore）为 1.17 ± 0.90，下睑为 0.70 ± 0.65；上睑的评分显著更高（p < 0.001）。平均 LLT 为 82.43 ± 24.52nm，平均不完全眨眼率为 51.04 ± 33.62%（0-100%）。CAS 是唯一与睑板腺评分相关的变量。不完全眨眼与睑裂高度或突眼程度之间无显著相关性。
由于不完全眨眼增加导致的泪膜不稳定可能导致 TED 中的干眼。除了 CAS 增加之外，睑板腺功能障碍也可能是 TED 中干眼的原因。然而，需要进一步的对比研究来证实这些结果。
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