Changes Of Ocular Surface Function In Thyroid-Associated Ophthalmopathy

Objective:To investigate the changes of ocular surface function and tear inflammatory cytokines in patients with thyroid associated ophthalmopathy.Methods:1.Case-control study.116 patients(231 eyes)who were first diagnosed with TAO in Shanxi Eye hospital from March 2018 to November 2019 were included.According to the activity,they were divided into two groups: 78 patients(156 eyes)in active TAO Group(35 men,43 women,age 46.54±10.55 years),36 patients(72 eyes)in inactive TAO Group(10 men,28 women,age 43.55±10.08 years).46 cases(92 eyes)in control group(15 men,31 women,age 46.30±10.45 years).Exophthalmos,palpebral fissure height,Graefe sign and bell sign were measured.TMH,NITBUT(f),NITBUT(av),lipid layer classification,meibomian gland loss area grade and corneal fluorescence staining score were measured by keratograph 5M ocular surface synthesis instrument.Chi square test for discrete variables,one-way ANOVA for continuous variables,the correlation analysis of the ocular surface function indexes in TAO patients with exophthalmos and palpebral fissure height was carried out,and the differences of the ocular surface function indexes in Graefe sign and Bell sign were statistically analyzed.2.Case-control study.From January 2019 to ecember 2019,25 patients(50 eyes)who were first diagnosed as active TAO in Shanxi Eye hospital were included as active TAO Group(10 males,15 females,age 46.84±10.33 years)and 12 cases(24 eyes)as control group(5 males,7 females,age 42.25±9.15 years).The tear samples of the twogroups were collected.The level of ICAM-1,IL-17 A and TNF-? in tears were detected by flow cytometry(CBA)and analyzed by t-test.Spearman correlation was used to analyze the relationship between cytokine level and CAS score.Results:1.NITBUT(f)and NITBUT(av)were significantly shorter in active TAO group and inactive TAO group than control group(P=0.000),there was no significant difference between active TAO group and inactive TAO group(P 0.05).The level of lipid layer was higher in active TAO group and inactive TAO group than con group(P < 0.05)the level of meibomian gland loss area was higher in active TAO group than con group(P <0.05)corneal fluorescence staining score was higher in active TAO group than inactive TAO group and con group(P < 0.05).TAO group s TMH,meibomian gland lack area was significantly positively correlated with exophthalmos,and the corneal fluorescence staining score was significantly positively correlated with exophthalmos and blepharospasm heights(both P <0.05).The corneal fluorescence staining score of TAO group with Graefe sign(+)was higher than that of Graoffe sign(-)(P <0.05),and the corneal fluorescence staining score of TAO group with Bell sign(-)was significantly higher than that of Bell sign(+)(P <0.05).2.Tear levels of ICAM-1(P = 0.002)and IL-17A(P < 0.001)appeared significantly higher in active TAO group than control group,Tear level of TNF-? has no statistically different from active TAO group and control group(P 0.05).Only 1 ICAM-1 was strongly positively correlated with CAS(r: 0.445,P=0.026).Conclusion:1.The damage of ocular surface function in TAO patients is mainly reflected in the shortening of tear break-up time,the uneven thickness of lipid layer,the increase of meibomian gland loss,and the aggravation of corneal damage.Mechanical factors are important causes of ocular surface dysfunction and ocular surface in ury.2.The increased expression of inflammatory cytokines in tears of patients with active TAO plays an important role in ocular surface in ury The tear level of ICAM-1can be used to evaluate the activity of TAO in part.