Risk Factors for Dry Eye in Thyroid-Associated Ophthalmopathy

Jae Ryun Kim; Hye Bin Yim; Sung Kun Chung

doi:10.3341/jkos.2011.52.7.771

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Kim, Yim, and Chung: Risk Factors for Dry Eye in Thyroid-Associated Ophthalmopathy

Original Article

J Korean Ophthalmol Soc 2011;52(7):771-776.

Published online: 7 September 2011

DOI: https://doi.org/10.3341/jkos.2011.52.7.771

Risk Factors for Dry Eye in Thyroid-Associated Ophthalmopathy

Jae Ryun Kim, MD, Hye Bin Yim, MD, PhD, Sung Kun Chung, MD, PhD

Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Korea

Address reprint requests to Sung Kun Chung, MD, PhD The Catholic University of Korea, Yeouido St. Mary's Hospital, #10, 63-ro, Yeongdeungpo-gu, Seoul 150-713, Korea Tel: 82-2-3779-1150, Fax: 82-2-3779-1150, E-mail: eyedoc@catholic.ac.kr

Received 30 December 2009 Revised 28 January 2011 Accepted 27 April 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the risk factors for dry eye in thyroid-associated ophthalmopathy patients.

Methods

The present retrospective study was conducted on 78 eyes in 39 patients diagnosed with thyroid-associated ophthalmopathy. The risk factors for dry eye in thyroid-associated ophthalmopathy patients were examined by analyzing data including tear breakup time, Schirmer's test, age, gender, thyroid function status, palpebral fissure width, lagophthalmos, eyelid retraction, and exophthalmos through multiple logistic regression analysis.

Results

The risk factors for dry eye disease were palpebral fissure width (OR = 3.422, p = 0.022) and lagophthalmos (OR = 13.068, p = 0.049). Age, gender, thyroid hormone status, eyelid retraction and exophthalmos did not show significant association with dry eye in multiple logistic regression analysis. The only risk factor for tear film breakup time less than 10 seconds was palpebral fissure width (OR = 2.787, p = 0.045), and none of the risk factors for Schirmer's test less than 10 mm at 5 minutes were statistically significant.

Conclusions

Risk factors for dry eye in thyroid ophthalmopathy patients were palpebral fissure width and lagophthalmos.

Keywords: Dry eye syndrome, Risk factors, Thyroid-associated ophthalmopathy

References

1. Rootman J, Dolman PJ. Thyroid Orbitopathy. 2nd ed.Philadelphia: Lippincott Williams & Wilkins;2003. p. 169–212.

2. Char DH. Thyroid eye disease. Br J Ophthalmol. 1996; 80:922–6.

3. Gilbard JP, Farris RL. Ocular surface drying and tear film osmolarity in thyroid eye disease. Acta Ophthalmol. 1983; 61:108–16.

4. Brasil MV, Brasil OF, Vieira RP, et al. Tear film analysis and its relation with palpebral fissure height and exophthalmos in Graves' ophthalmopathy. Arq Bras Oftalmol. 2005; 68:615–8.

5. Tsai CC, Kau HC, Kao SC, Hsu WM. Exophthalmos of patients with Graves' disease in Chinese of Taiwan. Eye. 2006; 20:569–73.

6. Tellez M, Cooper J, Edmonds C. Graves' ophthalmopathy in relation to cigarette smoking and ethnic origin. Clin Endocrinol. 1992; 36:291–4.

7. Woo KI, Kim YD, Lee SY; Korean Society of Ophthalmic Plastic and Reconstructive Surgery. The clinical characteristics of thyroid orbitopathy in thyroid dysfunction patients in Korea. J Korean Ophthalmol Soc. 2008; 49:1387–96.

8. Bartley GB, Fatourechi V, Kadrmas EF, et al. Clinical features of Graves' ophthalmopathy in an incidence cohort. Am J Ophthalmol. 1996; 121:284–90.

9. Eckstein AK, Plicht M, Lax H, et al. Thyrotropin receptor autoantibodies are independent risk factors for Graves' ophthalmopathy and help to predict severity and outcome of the disease. J Clin Endocrinol Metab. 2006; 91:3464–70.

10. Gerding MN, van der Meer JW, Broenink M, et al. Association of thyrotrophin receptor antibodies with the clinical features of Graves' ophthalmopathy. Clin Endocrinol. 2000; 52:267–71.

11. Mourits MP, Prummel MF, Wiersinga WM, Koornneef L. Clinical activity score as a guide in the management of patients with Graves' ophthalmopathy. Clin Endocrinol. 1997; 47:9–14.

12. Kaercher T, Bron AJ. Classification and diagnosis of dry eye. Dev Ophthalmol. 2008; 41:36–53.

13. Lemp MA, Dohlman CH, Kuwabara T, et al. Dry eye secondary to mucus deficiency. Trans Am Acad Ophthalmol Otolaryngol. 1971; 75:1223–7.

14. Jones LT. The lacrimal secretory system and its treatment. Am J Ophthalmol. 1966; 62:47–60.

15. Moses RA. The Eyelid. 8th ed.St. Louis: Mosby;1987. p. 11–36.

16. Kendler DL, Lippa J, Rootman J. The initial clinical characteristics of Graves' orbitopathy vary with age and sex. Arch Ophthalmol. 1993; 111:197–201.

17. Ko DA, Kim BJ, Kazim M. The epidemiologic and clinical characteristics of thyroid-associated orbitopathy. J Korean Ophthalmol Soc. 2006; 47:683–9.

18. Kohn LD, Harii N. Thyrotropin receptor autoantibodies (TSHRAbs): epitopes, origins and clinical significance. Autoimmunity. 2003; 36:331–7.

19. Kim WB, Chung HK, Park YJ, et al. Clinical significance of classification of Graves' disease according to the characteristics of TSH receptor antibodies. Korean J Intern Med. 2001; 16:187–200.

20. Kim WB, Chung HK, Park YJ, et al. The prevalence and clinical significance of blocking thyrotropin receptor antibodies in untreated hyperthyroid Graves' disease. Thyroid. 2000; 10:579–86.

21. Gomez JM, Soler J, Navarro MA. Thyroid stimulating antibodies in patients with Graves' ophthalmopathy. Thyroidology. 1991; 3:59–61.

22. Oh HJ, You IC, Yoon KC. Changes of tear parameters after using cyclosporine a in dry eye with thyroid ophthalmopahty. J Korean Ophthalmol Soc. 2007; 48:630–6.

23. Wiersinga WM, Prummel MF. Graves' ophthalmopathy: a rational approach to treatment. Trends Endocrinol Metab. 2002; 13:280–7.

24. Gayton JL. Etiology, prevalence, and treatment of dry eye disease. Clin Ophthalmol. 2009; 3:405–12.

25. Viso E, Rodriguez-Ares MT, Gude F. Prevalence of and associated factors for dry eye in a Spanish adult population (the Salnes Eye Study). Ophthalmic Epidemiol. 2009; 16:15–21.

26. Sahai A, Malik P. Dry eye: prevalence and attributable risk factors in a hospital-based population. Indian J Ophthalmol. 2005; 53:87–91.

27. Calonge M, Diebold Y, Sáez V, et al. Impression cytology of the ocular surface: a review. Exp Eye Res. 2004; 78:457–72.

28. Liang H, Baudouin C, Pauly A, Brignole-Baudouin F. Conjunctival and corneal reactions in rabbits following short- and repeated exposure to preservative-free tafluprost, commercially available latanoprost and 0.02% benzalkonium chloride. Br J Ophthalmol. 2008; 92:1275–82.

29. Xiong C, Chen D, Liu J, et al. A rabbit dry eye model induced by topical medication of a preservative benzalkonium chloride. Invest Ophthalmol Vis Sci. 2008; 49:1850–6.

Table 1.

Clinical manifestations of TAO^*

Clinical feature	Number of patients (%)
Abnormal tear film breakup time^†	49 (62.8)
Abnormal Schirmer test^‡	40 (51.3)
Eyelid retraction	32 (41.0)
Exophthalmos	31 (39.7)
Lagophthalmos	7 (9.0)

^* TAO = thyroid-associated ophthalmopathy

^† Abnormal tear film breakup time = tear film breakup time of less than 10 seconds

^‡ Abnormal Schirmer test = Schirmer test without topical anesthesia of less than 10 mm at 5 minutes.

Table 2.

Clinical characteristics associated with dry eye in patients with thyroid-associated ophthalmopathy

		Odd ratio	95% CI^†	p-value
Age (yr)	<30
	30–50	2.864	0.374–21.932	0.311
	>50	3.416	0.444–26.273	0.238
Sex	Male
	Female	1.452	0.389–5.417	0.579
Thyroid H. status	Normal
	Hypothyroidism	0.710	0.065–7.734	0.779
	Hyperthyroidism	1.018	0.325–3.185	0.976
TBII^*	Normal
	High	1.067	0.336–3.387	0.912
Palpebral fissure width (mm)	<11
	>11	3.422	1.197–9.780	0.022
Lid retraction	No
	Yes	0.936	0.304–2.881	0.908
Lagophthalmos	No
	Yes	13.068	1.013–168.575	0.049
Exophthalmos	No
	Yes	0.935	0.283–3.092	0.913

^* TBII = TSH binding inhibitor immunoglobulin

^† CI = confidence interval.

Table 3.

Clinical characteristics associated with tear film breakup time less than 10 sec in patients with thyroid-associated ophthalmopathy

		Odd ratio	95% CI^†	p-value
Age (yr)	<30
	30–50	2.381	0.174–10.155	0.28
	>50	3.425	0.275–14.432	0.13
Sex	Male
	Female	2.632	0.134–2.057	0.41
Thyroid H. status	Normal
	Hypothyroidism	0.495	0.067–4.390	0.512
	Hyperthyroidism	0.819	0.265–2.693	0.729
TBII^*	Normal
	High	1.375	0.276–2.772	0.572
Palpebral fissure width (mm)	<11
	>11	2.787	0.940–8.260	0.045
Lid retraction	No
	Yes	1.725	0.844–8.192	0.325
Lagophthalmos	No
	Yes	2.632	0.302–37.727	0.41
Exophthalmos	No
	Yes	1.086	0.345–3.418	0.888

^* TBII = TSH binding inhibitor immunoglobulin

^† CI = confidence interval.

Table 4.

Clinical characteristics associated with Schirmer test score less than 10 mm in patients with thyroid-associated ophthalmopathy

		Odd ratio	95% CI^†	p-value
Age (yr)	<30
	30–50	1.755	0.055–3.021	0.486
	>50	1.678	0.075–3.655	0.522
Sex	Male
	Female	1.958	0.535–6.447	0.261
Thyroid H. status	Normal
	Hypothyroidism	0.734	0.102–5.281	0.759
	Hyperthyroidism	0.686	0.237–1.992	0.489
TBII^*	Normal
	High	0.664	0.220–1.999	0.466
Palpebral fissure width (mm)	<11
	>11	2.59	0.868–6.297	0.075
Lid retraction	No
	Yes	1.655	0.582–4.709	0.345
Lagophthalmos	No
	Yes	1.907	0.142–6.292	0.487
Exophthalmos	No
	Yes	1.695	0.558–5.147	0.352

^* TBII = TSH binding inhibitor immunoglobulin

^† CI = confidence interval.

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