Clinical Features of Dry Eye in Thyroid-Associated Ophthalmopathy According to Disease Activity

Jun Young Ha; Won Choi; Kyung Chul Yoon

doi:10.3341/jkos.2016.57.7.1037

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Ha, Choi, and Yoon: Clinical Features of Dry Eye in Thyroid-Associated Ophthalmopathy According to Disease Activity

Original Article

J Korean Ophthalmol Soc 2016;57(7):1037-1043.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.7.1037

Clinical Features of Dry Eye in Thyroid-Associated Ophthalmopathy According to Disease Activity

Jun Young Ha, MD, Won Choi, MD, Kyung Chul Yoon, MD, PhD

Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea

Address reprint requests to Kyung Chul Yoon, MD, PhD Department of Ophthalmology, Chonnam National University Hospital, #42 Jebong-ro, Dong-gu, Gwangju 61469, Korea Tel: 82-62-220-6741, Fax: 82-62-227-1642 E-mail: kcyoon@jnu.ac.kr

Received 24 December 2015 Accepted 24 March 2016

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 evaluate the clinical features of dry eye in thyroid-associated ophthalmopathy (TAO) according to disease activity and analyze the related factors.

Methods

This study included 157 patients diagnosed with TAO and dry eye between March 2009 and March 2015. According to the clinical activity score (CAS), TAO patients were divided into inactive (CAS < 3) and active (CAS ≥ 3) groups. Clinical features included age, sex, visual acuity, proptosis, palpebral fissure width, orbital computed tomography (CT) findings, thyroid hormones, and ocular surface parameters including tear film break-up time (TFBUT), Schirmer tests, keratoepitheliopathy scores, and ocular surface disease index (OSDI) were obtained and compared between the groups. In addition, correlations between clinical features and ocular surface parameters were analyzed in both groups.

Results

In the inactive and active TAO groups, CAS was 1.24 ± 0.69 and 4.23 ± 1.13, respectively (p = 0.001). Thyrotropin-binding inhibitory immunoglobulin was significantly higher in the active TAO group than in the inactive TAO group (p = 0.048). On orbital CT, extraocular muscle hypertrophy was more common in the active TAO group than the inactive TAO group (p = 0.020). No significant difference was found in age, sex, visual acuity, free T4, and thyroid-stimulating hormone between the two groups. During analysis of the tear film and ocular surface parameters, TFBUT (p = 0.006) was shorter and OSDI score (p = 0.028) was higher in the active TAO group than the inactive TAO group. TFBUT was negatively correlated with proptosis (r = −0.432, p = 0.001; r = −0.308, p = 0.032) and palpebral fissure width (r = −0.367 p = 0.012; r = −0.312, p = 0.031) in both groups. OSDI was positively correlated with proptosis in the active TAO group (r = 0.301, p = 0.033).

Conclusions

TFBUT was shorter and OSDI score higher in dry eye patients with active TAO than in patients with inactive TAO. The TFBUT was negatively correlated with proptosis and palpebral fissure width in both groups.

Keywords: Clinical activity score, Correlation, Dry eye, Thyroid-associated ophthalmopathy

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Figure 1.

Correlations between proptosis and tear film break-up time (TFBUT) in the inactive (A) and active (B) thyroid-associated ophthalmopathy groups.

Figure 2.

Correlations between palpebral fissure width and tear film break-up time (TFBUT) in the inactive (A) and active (B) thyroid-associated ophthalmopathy groups.

Figure 3.

Correlations between proptosis and ocular surface disease index (OSDI) score in the inactive (A) and active (B) thy-roid-associated ophthalmopathy groups.

Table 1.

Clinical features of thyroid-associated ophthalmopathy patients with dry eye according to disease activity

	CAS < 3 (n = 90)	CAS ≥ 3 (n = 67)	p-value
Mean age (years)^*	41.58 ± 15.50	44.18 ± 10.84	0.224
Sex (male/female)^† (n, %)	19/71 (21.1/78.9)	21/46 (31.3/68.7)	0.172
Visual acuity (log MAR)^*	0.05 ± 0.19	0.11 ± 0.39	0.378
Clinical activity score^*	1.24 ± 0.69	4.23 ± 1.13	0.001
Proptosis (mm)^*	16.37 ± 1.54	17.01 ± 1.72	0.060
Palpebral fissure width (mm)^*	12.21 ± 1.17	12.34 ± 1.02	0.125
EOM enlargement in orbital CT^† (n, %)	35 (38.9)	39 (58.2)	0.020
Thyroid hormone state
Hyperthyroid state^† (n, %)	47 (52.2)	40 (59.7)	0.069
Euthryoid state^† (n, %)	39 (43.3)	15 (22.4)	0.090
Hypothyroid state^† (n, %)	4 (4.4)	2 (3.0)	0.053
Thyroid hormone
TSH (μ IU/mL)^*	3.73 ± 11.99	2.35 ± 0.47	0.761
fT4 (ng/dL)^*	1.67 ± 1.04	1.38 ± 0.53	0.388
TBII (IU/L)^*	6.22 ± 7.54	8.05 ± 4.15	0.048

Values are presented as mean ± SD unless otherwise indicated.

CAS = clinical activity score; log MAR = logarithm of the minimum angle of resolution; EOM = extraocular muscle; CT = computed tomography; TSH = thyroid stimulating hormone; fT4 = free tetraiodothyronine 4; TBII = thyrotropin binding inhibitor immunoglobulin.

^* Student t-test

^† Chi-square test, Fisher exact test.

Table 2.

Comparisons of the tear film and ocular surface parameters between inactive and active thyroid-associated ophthalmopathy patients

	CAS < 3 (n = 90)	CAS ≥ 3 (n = 67)	p-value
Tear film break-up time (sec)^*	7.20 ± 1.25	5.37 ± 1.84	0.006
Schirmer test (mm)^*	8.75 ± 2.19	8.28 ± 1.39	0.053
Keratoepitheliopathy score^*	1.59 ± 0.14	2.54 ± 0.86	0.061
OSDI score^*	47.11 ± 10.13	53.35 ± 12.84	0.028

Values are presented as mean ± SD unless otherwise indicated.

CAS = clinical activity score; OSDI = ocular surface disease index

^* Student t-test.

Table 3.

Correlation analysis in inactive thyroid-associated ophthalmopathy patients

		TFBUT	Schirmer test	Keratoepitheliopathy score	OSDI score
Age	Correlation coefficient	–0.053	–0.294	0.034	0.010
	p-value	0.758	0.090	0.714	0.921
Proptosis	Correlation coefficient	–0.432	–0.142	0.129	0.254
	p-value	0.001	0.370	0.421	0.093
Palpebral fissure width	Correlation coefficient	–0.367	–0.246	0.118	–0.164
	p-value	0.012	0.098	0.422	0.339
TSH	Correlation coefficient	–0.104	–0.240	0.152	–0.257
	p-value	0.460	0.109	0.370	0.091
fT4	Correlation coefficient	–0.136	0.155	–0.183	–0.142
	p-value	0.412	0.364	0.330	0.370
TBII	Correlation coefficient	–0.008	–0.119	0.065	–0.048
	p-value	0.963	0.421	0.773	0.728

TFBUT = tear film break-up time; OSDI = ocular surface disease index; TSH = thyroid stimulating hormone; fT4 = free tetraiodothyronine; TBII = thyrotropin binding inhibitor immunoglobulin.

Table 4.

Correlation analysis in active thyroid-associated ophthalmopathy patients

		TFBUT	Schirmer test	Keratoepitheliopathy score	OSDI score
Age	Correlation coefficient	–0.182	–0.009	–0.050	0.041
	p-value	0.334	0.962	0.779	0.709
Proptosis	Correlation coefficient	–0.308	–0.172	0.022	0.301
	p-value	0.032	0.337	0.871	0.033
Palpebral fissure width	Correlation coefficient	–0.312	–0.237	0.134	–0.164
	p-value	0.031	0.112	0.418	0.339
TSH	Correlation coefficient	0.120	0.216	–0.049	–0.051
	p-value	0.421	0.185	0.780	0.778
fT4	Correlation coefficient	–0.266	0.167	–0.137	–0.295
	p-value	0.102	0.321	0.375	0.088
TBII	Correlation coefficient	–0.222	–0.256	0.244	0.136
	p-value	0.172	0.092	0.094	0.412

TFBUT = tear film break-up time; OSDI = ocular surface disease index; TSH = thyroid stimulating hormone; fT4 = free tetraiodothyronine; TBII = thyrotropin binding inhibitor immunoglobulin.

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