目的:探讨未经治疗的甲状腺眼病(TED)患者睑板腺功能障碍(MGD)和眼表暴露与泪膜不稳定的关系。
方法:对2020年9月至2022年9月的TED患者进行了横断面研究。眼表参数包括眼表疾病指数(OSDI),撕裂弯月面高度(TMH),非侵入性泪液破裂时间(NITBUT),部分闪烁率,脂质层厚度(LLT),睑板腺脱落(meibopore),Schirmer\'stest,和角膜点状上皮糜烂(PEE)。通过上眼睑和下眼睑的边缘反射距离(MR1和MR2)评估眼部表面暴露,眼球突出的数量,侧向耀斑,还有眼药水.
结果:总计,来自76名TED患者的152只眼(64名女性和12名男性,年龄42.99±12.28岁)和61例健康对照者的93只眼(51例女性和10例男性,年龄43.52±17.93岁)进行检查。与对照眼相比,TED的眼睛有更高的OSDI,TMH,LLT,和PEE;NITBUT较短;meiboscore较差(均p<0.05)。他们也有大量的眼球突出,更长的MRD1,更多的侧向耀斑,还有眼药水.多变量分析确定了泪膜不稳定与下眼睑中的眩眼(β=-1.13,95CI:-2.08,-0.18)和严重MGD(β=-5.01,95CI=-7.59,-2.43)的相关性。
结论:TED干眼症主要表现为蒸发性干眼病。在未接受治疗的TED患者中,严重的下眼睑MGD和严重的眼睑下垂与泪膜不稳定显着相关。
OBJECTIVE: To investigate the association of meibomian gland dysfunction (MGD) and ocular surface exposure with tear film instability in untreated thyroid eye disease (TED) patients.
METHODS: A cross-sectional study of TED patients from September 2020 to September 2022 was conducted. Ocular surface parameters included ocular surface disease index (OSDI), tear meniscus height (TMH), non-invasive tear break-up time (NITBUT), partial blinking rate, lipid layer thickness (LLT), meibomian gland dropout (meiboscore), Schirmer\'s test, and corneal punctate epithelial erosions (PEE). Ocular surface exposure was assessed by the margin reflex distances of the upper and lower eyelid (MRD1 and MRD2), the amount of exophthalmos, lateral flare, and
lagophthalmos.
RESULTS: In total, 152 eyes from 76 TED patients (64 females and 12 males, age 42.99 ± 12.28 years) and 93 eyes from 61 healthy controls (51 females and 10 males, age 43.52 ± 17.93 years) were examined. Compared with control eyes, TED eyes had higher OSDI, TMH, LLT, and PEE; shorter NITBUT; and worse meiboscore (all p < 0.05). They also had larger amounts of exophthalmos, longer MRD1, more lateral flare, and
lagophthalmos. Multivariate analysis identified an association of the tear film instability with
lagophthalmos (β = -1.13, 95%CI: -2.08, -0.18) and severe MGD in the lower eyelid (β = -5.01, 95%CI = -7.59, -2.43).
CONCLUSIONS: Dry eye in TED is mainly manifested as evaporative dry eye disease. Severe lower eyelid MGD and worse
lagophthalmos were significantly associated with tear film instability in treatment-naive TED patients.