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Eduardo M Rocha, Monica Alves, Denny M Garcia; Diagnostic correlates indicative of dry eye disease related with Graves orbitopathy. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1973.
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© ARVO (1962-2015); The Authors (2016-present)
To determine in Graves orbitopathy (GO) patients whether or not their diagnosis is characterized by specific symptom sets. They include dry eye signs and ocular surface alterations. Such an assessment was undertaken to obtain a better understanding of the pathophysiological mechanisms underlying dry eye disease (DED) and GO.
GO patients were subjected to ocular surface evaluation; tear flow measurements and tear film osmolarity (TFOsm). Dry eye disease diagnosis was made if: Ocular Surface Disease Index (OSDI) score > 20 and/or Schirmer test (ST) <10 mm and/or tear break up time (TFBUT) ≤ 6 seconds and/or any of the vital staining (corneal fluorescein, CF and lissamine green conjunctival LG) > 3 and/or tear film osmolarity > 310 mOsm. DED severity was categorized based on a method adapted from the Dry Eye Workshop (DEWS). Spontaneous blinking rate (SBR) was measured in patients using magnetic search coil method for five minutes during video watching.
Twenty eight GO patients. Their mean ± SD age was 41.3 ± 12.5 years and gender ratio was 4M:24F. The time of disease was 92.6 ± 50 months. All were diagnosed with DED. Among them, were considered positive: OSDI: 92.9 % (47.1±18.8), ST: 35.7 % (15.7±12.3), TFBUT: 67.9% (5.4±3.2), TFOsm: 28.6 % (300.2±15.5), LG: 7.1% (1.2±1.3), CF: 3.6 % (0.7±1.2). DED severity was majority graded 2 (89.3%). SBR was 18.2 ± 8.7 blinks/min. The most relevant correlations were: TFBUT vs age (-0.489; p = 0.008), SBR vs TFOsm (-0.832, p = 0.040) and LG (0.399; p = 0.035), OSDI (-0.43; p=0.036) and ST (-0.463; p=0.023) vs time of disease. Stepwise multiple regression indicated that TFBUT decrease with LG and age, TFOsm decrease with time of disease and ST.
This study confirms that GO is frequently associated with DED. Furthermore, in GO there is a close correlation between the increase tear film osmolarity and ocular surface damage and declines of spontaneous blinking rate. Moreover, the time of disease seems to be a important factor in changes in DED conditions in GO. These findings will benefit efforts to design future studies to clarify the mechanisms underlying GO.
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