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Michael Chua, Lauren Tomlinson, Gil Binenbaum, William Katowitz; Clinical Characterization of Pediatric Thyroid Eye Disease. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5162.
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© ARVO (1962-2015); The Authors (2016-present)
Thyroid eye disease (TED) is typically less severe and less common in children than in adults. We reviewed the presentation, severity, and surgical interventions of thyroid eye disease (TED) in children at a single institution over a 14-year period.
Retrospective cohort study of children 0 to 18 years of age with a diagnosis of TED, seen at The Children’s Hospital of Philadelphia from 2002 to 2016. Ophthalmic examination findings, neuroimaging study results, thyroid dysfunction treatment, and ophthalmological management, including orbital decompression surgery, were recorded. T-tests were used to test for statistical significance.
A total of 67 subjects with TED were studied: 59 female, 8 male. Mean age at diagnosis of TED was 11.6 years (SD 4.2, range 2.3-17.9). Mean follow-up was 2.4 years (SD 2.4). All subjects had proptosis (67, 100%). Other findings included eyelid retraction in 46 (69%), chemosis in 7 (10.4%), punctate epithelial erosions in 8 (12%), and strabismus in 6 (9%) subjects. No children had evidence of optic neuropathy. Twenty-one children (31%) reported dry eye symptoms. Mean exophthalmometry was 21.5 mm (SD 2.7). Four children received orbital decompression surgery for exposure keratopathy and disfigurement. Mean pre-operative and post-operative exophthalmometry for these children was 22.5 mm (SD 3.0) and 17.9mm (SD 2.4), respectively, which was a significant decrease, (p<0.0001). None of these patients had serious complications from surgery, but all had significant cosmetic improvement and resolution of exposure keratopathy.
Most children with TED exhibit relatively mild symptoms of proptosis and eyelid retraction without strabismus or vision loss. However, some children have severe disfigurement and corneal exposure due to TED and benefit from orbital decompression.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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