Liao Xulin, Lai Kenneth Ka Hei, Aljufairi Fatema Mohamed Ali Abdulla, Chen Wanxue, Hu Zhichao, Wong Hanson Yiu Man, Jia Ruofan, Wei Yingying, Tham Clement Chee Yung, Pang Chi Pui, Chong Kelvin Kam Lung
Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China.
Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong SAR, China.
J Clin Med. 2023 Apr 23;12(9):3066. doi: 10.3390/jcm12093066.
To investigate the association of meibomian gland dysfunction (MGD) and ocular surface exposure with tear film instability in untreated thyroid eye disease (TED) patients.
A cross-sectional study of TED patients from September 2020 to September 2022 was conducted. Ocular surface parameters included ocular surface disease index (OSDI), tear meniscus height (TMH), non-invasive tear break-up time (NITBUT), partial blinking rate, lipid layer thickness (LLT), meibomian gland dropout (meiboscore), Schirmer's test, and corneal punctate epithelial erosions (PEE). Ocular surface exposure was assessed by the margin reflex distances of the upper and lower eyelid (MRD1 and MRD2), the amount of exophthalmos, lateral flare, and lagophthalmos.
In total, 152 eyes from 76 TED patients (64 females and 12 males, age 42.99 ± 12.28 years) and 93 eyes from 61 healthy controls (51 females and 10 males, age 43.52 ± 17.93 years) were examined. Compared with control eyes, TED eyes had higher OSDI, TMH, LLT, and PEE; shorter NITBUT; and worse meiboscore (all < 0.05). They also had larger amounts of exophthalmos, longer MRD1, more lateral flare, and lagophthalmos. Multivariate analysis identified an association of the tear film instability with lagophthalmos (β = -1.13, 95%CI: -2.08, -0.18) and severe MGD in the lower eyelid (β = -5.01, 95%CI = -7.59, -2.43).
Dry eye in TED is mainly manifested as evaporative dry eye disease. Severe lower eyelid MGD and worse lagophthalmos were significantly associated with tear film instability in treatment-naive TED patients.
探讨未经治疗的甲状腺眼病（TED）患者睑板腺功能障碍（MGD）和眼表暴露与泪膜稳定性之间的关联。
对2020年9月至2022年9月的TED患者进行横断面研究。眼表参数包括眼表疾病指数（OSDI）、泪河高度（TMH）、非侵入性泪膜破裂时间（NITBUT）、部分眨眼率、脂质层厚度（LLT）、睑板腺缺失（睑板腺评分）、泪液分泌试验和角膜点状上皮糜烂（PEE）。通过上下眼睑缘反射距离（MRD1和MRD2）、眼球突出量、外侧flare和兔眼来评估眼表暴露情况。
共检查了76例TED患者（64例女性和12例男性，年龄42.99±12.28岁）的152只眼和61例健康对照者（51例女性和10例男性，年龄43.52±17.93岁）的93只眼。与对照眼相比，TED眼的OSDI、TMH、LLT和PEE更高；NITBUT更短；睑板腺评分更差（均P<0.05）。它们还具有更大的眼球突出量、更长的MRD1、更多的外侧flare和兔眼。多变量分析确定泪膜稳定性与兔眼（β=-1.13，95%CI：-2.08，-0.18）和下睑严重MGD（β=-5.01，95%CI=-7.59，-2.43）有关。
TED中的干眼主要表现为蒸发型干眼疾病。在未经治疗的TED患者中，严重的下睑MGD和更严重的兔眼与泪膜稳定性显著相关。
