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Occult thyroid eye disease may present with dry eye symptoms
Am J Ophthalmol. 2009;147(5):919-923.
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Occult thyroid eye disease may cause inflammatory ocular surface disease presenting with dry eye symptoms, according to a study.
"Occult [thyroid eye disease] 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," the study authors said.
The retrospective, observational case series included 539 patients referred for dry eye in a 2-year period; 21 patients were diagnosed with thyroid eye disease, based on orbital echography. Mean patient age was 57 years (range, 24 years to 78 years); 86% of patients were women.
A suspicion of thyroid eye disease was based on conjunctival hyperemia with or without chemosis localized in the extraocular muscles (100%) and slight widening of interpalpebral fissure (48%), the authors said.
Clinical findings for thyroid eye disease comprised corneal fluorescein staining (57%), rapid tear film break up (31%) and abnormal Schirmer test results (19%). Other rheumatologic conditions related to dry eye included Sjögren's syndrome (three patients) and rheumatoid arthritis (one patient).
Patients received topical cyclosporine 0.05% two to four times daily, with or without steroids. Warm compresses, artificial tears and punctal plugs were also used as needed.
Symptoms improved in 75% of patients, the authors said.