Department of Ophthalmology, Ansan Hospital, Korea University College of Medicine, 123 Jeokkumro, Ansan-shi, Kyunggi-do, 15355, Republic of Korea.
Department of Ophthalmology, Guro Hospital, Korea University College of Medicine, 148 Gurodongro, Seoul, 08308, Republic of Korea.
BMC Ophthalmol. 2021 Oct 11;21(1):361. doi: 10.1186/s12886-021-02107-x.
To investigate the incidence of absent Bell's phenomenon (BP) and the relationship between absent BP and inferior rectus muscle hypertrophy and other clinical features in patients with thyroid eye disease (TED).
A total of 104 patients who were first diagnosed with TED between January and December 2014 were included. Inferior rectus muscle area and associations with clinical features of TED and thyroid function test including thyroid specific antibodies were compared between patients with TED with and without BP. The volume of the inferior rectus muscle was calculated by adding up all the cross-sectional areas measured on sagittal CT images.
Among the 104 patients, 14 had absent BP (13.5%), 12 with bilateral and two with unilateral. There was no significant difference in thyroid function test, presence of TSIs, exophthalmos, or volume of inferior rectus muscle measured in CT scans (P > 0.05). Incidence of diplopia, elevation limitation, and upper eyelid retraction were risk factors of absent BP in TED patients (by logistic regression analysis, P < 0.05).
Inferior rectus muscle hypertrophy was not the cause of absent BP in TED patients. Fibrosis and tightening of the inferior rectus muscle, lower eyelid, and surrounding orbital tissues, rather than inferior rectus muscle hypertrophy, might be related to absent BP in TED patients.
研究甲状腺眼病（TED）患者中 Bell 现象缺失（BP）的发生率，以及 BP 缺失与下直肌肥大和其他临床特征之间的关系。
纳入 2014 年 1 月至 12 月期间首次诊断为 TED 的 104 例患者。比较 TED 伴或不伴 BP 的患者的下直肌面积及其与 TED 和甲状腺功能试验（包括甲状腺特异性抗体）的临床特征的关系。通过将矢状 CT 图像上测量的所有横截面积相加来计算下直肌体积。
104 例患者中，14 例（13.5%）存在 BP 缺失，其中 12 例为双侧，2 例为单侧。甲状腺功能试验、TSI 存在、突眼或 CT 扫描测量的下直肌体积均无显著差异（P>0.05）。复视、上睑提升受限和上睑退缩是 TED 患者 BP 缺失的危险因素（通过逻辑回归分析，P<0.05）。
下直肌肥大不是 TED 患者 BP 缺失的原因。下直肌、下睑和周围眶组织的纤维化和紧缩，而不是下直肌肥大，可能与 TED 患者 BP 缺失有关。
