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GH Hanselmayer, G Zettinig, B Fueger, A Hofmann, G Schild, G Schmidinger, J Nepp; Radioiodine Therapy Affects Lacrimal Gland Function: A Cross-Sectional Study . Invest. Ophthalmol. Vis. Sci. 2002;43(13):97.
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Purpose:Although impairment of lacrimal gland function after external radiation is well documented, there are no studies evaluating the long-term effect of incorporated radioactivity on the lacrimal glands. Radioiodine therapy is the standard treatment for thyroid cancer and an established therapy for Grave’s disease and toxic nodular goiter. After oral administration, radioiodine accumulates not only in the thyroid but also in several other tissues such as the lacrimal glands. Methods:We investigated 182 eyes of 90 patients with a history of radioiodine therapy from thyroid carcinoma (mean age 55 ± 15 years, range 17-81 years, 69 females) and compared them to a sex- and age matched control group. All patients had been given at least 2960 MBq 131-I (maximal administered activity 22.2 GBq 131-I). An ophthalmologic investigation was performed 64 ± 71 months (range 1 - 317 months) after the initial radioiodine therapy by a single ophthalmologist (G.H.). Lacrimal gland function was evaluated with 3 different objective tests and a detailed ophthalmological anamnesis and was compared to the findings in the controls. Patients with factors known to affect lacrimal gland function (contact lenses, autoimmune disorders, history of additional radiation exposure) were excluded from the study. Results:A total of 78 patients (70,2%) had at least one abnormal objective test indicating impaired lacrimal gland function: A decreased tear film break up time (<5 sec) was found in 64 patients (57,6%) in at least one eye and in 51 patients (45,9%) in both eyes. Schirmer’s tear test was decreased (<10mm/5min) in 47 patients (42,3%) in at least one eye and in 30 patients in both eyes. A definitely abnormal Schirmer test (<5mm/5min) was seen in 20 patients (18%) in both eyes and in 32 patients (28,8%) in at least one eye. The lacrimal lipidlayer was impaired in 43 patients (38,7%) in at least one eye and 31 patients (27,9%) in both eyes. Thirty-seven individuals (33,3%) had changes in the external eye morphology. Objective lacrimal function test results and clinical symptoms did not correlate with the total administered amount of radioiodine or with the time period since initial radioiodine treatment. Schirmer’s tear test (p<0.05), break up time (p<0.05), and lipid phase interference (p<0.01) were all significantly reduced in the study group compared to the control group. Conclusion:These findings demonstrate a significantly impaired lacrimal gland function after high dose radioiodine therapy with at least 2960 MBq 131-I.
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