RESEARCH - Occult thyroid eye disease in patients with dry eye symptoms

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Am J Ophthalmol. 2009 May;147(5):919-23. Epub 2009 Feb 10.

Occult thyroid eye disease in patients presenting with dry eye symptoms.

Gupta A, Sadeghi PB, Akpek EK.

Wilmer Eye Institute, s Hopkins University, Baltimore, land 21287, USA.

PURPOSE: To describe the clinical presentation, laboratory features,

and treatment outcomes in a series of patients with occult thyroid eye

disease (TED). DESIGN: Retrospective observational case series.

METHODS: Among 539 patients who were referred for dry eye evaluation

over 2 years, 21 were diagnosed with occult TED, based on typical

findings in orbital echography. Medical records of these patients were

reviewed to collect information on demographics, clinical findings,

laboratory studies, and treatment response.

RESULTS: All patients presented with symptoms of dry eye. Median age

of patients was 57 years (range, 24 to 78 years), with the majority

female (86%). No patients carried prior diagnosis of TED or had

typical findings of TED such as proptosis, dysmotility, or diplopia.

Suspicion of TED was based on conjunctival hyperemia with or without

chemosis localized to extraocular muscles (100%), and subtle widening

of interpalpebral fissure (48%). Clinical findings included corneal

fluorescein staining (57%), rapid tear break-up time (31%), and

abnormal Schirmer test (19%). Nineteen percent of patients had other

rheumatologic disorders commonly associated with dry eye: Sjögren

syndrome (n = 3), and rheumatoid arthritis (n = 1). Patients were

treated topically using cyclosporine 0.05% 2 to 4 times a day, with or

without steroid. Other treatments were also employed as necessary

including warm compresses, artificial tears, and puntal plugs.

Majority of patients (76%) had improvement of their symptoms.

CONCLUSION: Occult TED is a potential cause of inflammatory ocular

surface disease with dry eye symptomatology and should be considered

in the differential diagnosis when evaluating dry eye patients.

PMID: 19211095

http://www.ncbi.nlm.nih.gov/pubmed/19211095

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