| PurposeThyroid associated ophthalmopathy(TAO) is the most common autoimmune orbital disease in adult, mainly involving the orbital fat and extraocular muscle, and most patients with TAO have foreign body sensation, dryness, photophobia, fear of wind, tears, etc. The literatures showed that autoimmune disease is a risk factor for dry eyes, and the epidemiological study showed that the prevalence of dry eye in patients with TAO is 45% ~ 85%. The mechanisms of dry eye in patients with TAO is that eyelid retreat, exophthalmos and palpebral fissure broadening lead to ocular surface evaporation and high tear osmotic pressure, causing dry eyes in previous studies. In recent years, some research suggested that the inflammation of TAO is a major cause of dry eyes occurred.TAO patients may have the difference of the incidence, tear and cornea in different clinical stages, but now such research is less. So 281 patients with TAO were divided into groups in this study. We observe that the incidence of dry eye in patients with TAO, the incidence of dry eye in inflammatory active period and inactive period, and the incidence of dry eye short, medium, long three course group.According to the CAS score, they were divided into two groups observation to clinical staging, activity of and course group, observe the incidence of this group of patients with TAO overall dry eyes and dry eye examination result, TAO inflammatory activity and the activity the incidence of dry eyes, TAO short, medium, long three course group, the prevalence of dry eye. And we analyze the characteristics of dry eyes in different periods in order to provide an objective basis for the change of the tear film and cornea and look for the right solution in different clinical stages of inflammatory activity. Materials and Methods 1 Research objects and groupingA total of 281 TAO patients whose date were collected in our hospital from January to December in 2014. Including 114 males and 167 females, patients age from 9years old to 69 years old, the average age is(43.2±0.8) years old, of which 2 weeks to 14 years is the course of TAO. Limiting factors :(1) according to the diagnostic criteria of Bartley;(2) without anti-inflammatory drugs and artificial tears;(3) complete ophthalmic testing. Exclusion criteria:(1) autommune diseases;(2) other eye dieases;(3) wearing corneal contact lens;(4) patients with pregnancy or lactation;(5) work environment with strong light or chemical volatiles. According to the CAS score, they were divided into two groups as TAO active period(CAS≥4 points, 96cases) and TAO inactive period group(CAS < 4points, 185cases). According to the course of the disease, they were divided into three groups as short(course <1a, 180 cases)、 middle(course 1~2a, 46 cases) and long course(course>2a, 55 cases).This research program was approved by the Institutional Review Board of Zhengzhou University. All of the patients had signed informed consent. 2 MethodsObserve and record the age, gender, duration of TAO, dry eye symptoms of patients, then Schirmer I test(SIt), break- up time(BUT) and cornea fluorescent staining(FS). SIt evaluation standard: record the wet length of paper; BUT evaluation criteria: the break-up time of tear film measured three times; FS evaluation criteria: the cornea is divided into four quadrants, and each quadrant score is 0 to 3 points. 3 Statistical analysisUsing SAS 9.1 statistical software to analyze all the data. The levels of course, SIt, BUT and FS were expressed in the form of the x±s. The incidence of comparison between groups used c2 test; Each group of data carried on the test of normality and the homogeneity of variance, then used rank sum test. The significance level was P < 0.05. Results 1 The incidence of dry eye in patients with TAOThe incidence of dry eye is 65.48% in 281 patients.The course of 184 patients range 2 months to 7 years, the average months(14.3 + 1.0). 2 The incidence of active period and inactive period in patients with TAOThe incidence of TAO active period and TAO inactive period were 77.08% and 59.46%, and two period had statistical significance(c2=8.685,P=0.003). 3 The incidence of short, medium and long duration group in patients with TAOThe incidence of short, medium and long course were 68.89%, 69.57% and 50.91%. Short course and long course had statistical significance(c2=5.961,P =0.015). 4 The tests of patients with TAOThere were 281 cases(562 eyes) in this study. There were 154 eyes(27.40%) with 5 mm/min under, 168 eyes(29.89%) with 5 mm/min / 5 ~ 10 mm min and 240 eyes(42.70%) with more than 10 mm / 5 min. There were 297 eyes(52.85%) with under 5 s, 221 eyes(39.32%) with 5 s ~ 10 s and 44 eyes(7.83%) with more than 10 s. There were 365 eyes(64.95%) with 0 point, 142 eyes(25.27%) with 1 ~ 3 point and 55 eyes(9.79%) with more than 3 point. 5 The characteristics of active period and inactive period in patients with TAOThe SIt of active period(12.65±7.79) mm / 5 min is higher than inactive period(11.93±9.87) mm / 5 min(P < 0.05). The BUT of active period(4.81±2.43) s is shorter than inactive period(6.07±3.05) s(P < 0.05). The FS of active period(1.16±2.01) is higher than inactive period(0.80±1.80)(P < 0.05). 6 The characteristics of short, medium and long course group in patients with TAOThe SIt of short, medium and long course group are(12.70 + 8.83) mm / 5 min,(10.75-8.70) mm / 5 min and(13.84 + 10.02) mm / 5 min, and there was no statistically significant difference(H=5.716,P=0.057). The BUT of short, medium and long course group are(5.51-2.95) s,(5.31-2.23) s,(6.22-3.15) s, and there was no statistically significant difference(H=4.636,P=0.099). The FS of short, medium and long course group are(1.13 + 2.09),(0.62-1.73),(0.50-1.19), and the difference has statistically significance(H=18.184,P=0.0001). ConclusionsThe incidence of dry eye in TAO patients is higher than normal person. The vast majority of patients with TAO appear unstable in tear film, more than half of patients with TAO is inadequate in tear secretion, and about a one of third patients with TAO is damaged in corneal epithelium. There were different in TAO active、inactive period and different course. Inflammation is a key factor in the pathogenesis of dry eye with TAO.The incidence of dry eye reduced in the patients with course>2a, and the stability of tear film is still lower than normal level. |
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