Avaliação da superfície ocular em pacientes com doença ocular da tireoide

Abstract

Introduction: Thyroid eye disease (TED) is the most common and severe extrathyroidal manifestation in patients with Graves' disease, affecting 25-50% of these patients. Ocular surface disease (OSD) is a multifactorial disorder characterised by an imbalance in tear film homeostasis, resulting from deficient tear production and/or excessive tear evaporation. In TED, the enlargement of the palpebral fissure, combined with eyelid changes and proptosis, results in increased corneal exposure, tear film instability, accelerated tear evaporation, and increased tear osmolarity. OSD in the context of TED is traditionally considered a natural consequence of these anatomical changes. However, a growing body of research suggests that ocular surface inflammation and multifactorial alterations in ocular surface homeostasis contribute substantially to the OSD observed in patients with TED. Objective: to analyse the association between ocular surface disease (OSD) and thyroid eye disease (TED) in the active and inactive phases in patients followed at two SUS care services: (i) Ophthalmology Services, Professor Francisco Magalhães Neto Outpatient Clinic (AMN), HUPES complex, UFBA; and (ii) Ophthalmology Outpatient Clinic, Santo Antônio Hospital, Irmã Dulce Social Works (OSID). Material and Methods: this is a multicenter, cross-sectional, observational, and analytical cohort study. The study population consisted of 51 patients, corresponding to 102 eyes, of TED patients followed at the Ocular Plastic Surgery outpatient clinics of the Ophthalmology services of AMN/HUPES and OSID. Results: the mean age was 47.92 (±13.21) years. The female-to-male ratio in our study was 2.92:1. Considering the inflammatory activity of TED, 42/51 (82.4%) eyes were in the inactive phase (CAS < 3) and 9/51 (17.6%) were in the active phase of the disease (CAS ≥ 3), considering for the calculation, the eye with the highest CAS value, in asymmetric orbital disease. The majority (88.2%) of the eyes presented normal values in the Schirmer test with an anaesthetic. Only 6/51 (11.8%) eyes presented normal results in the BUT. Regarding staining with fluorescein and lissamine green, 21/51 (41.2%) and 7/51 (13.7%), respectively, of the eyes had positive results for DSO. The mean OSDI score was higher in the inflammatory DOT group (18.64 ± 13.08), compared to patients with inactive DOT (14.88 ± 10.89). Three-nine (33.3%) eyes presented features of MGD on biomicroscopy. Conclusion: We conclude that OSD is quite prevalent in patients with TED. However, interpreting the results of all current diagnostic tests for OSD remains difficult due to their frequent discordance and low correlation, especially in the OSD patients evaluated. In our sample, the strongest correlations were observed between lissamine green/Schirmer and fluorescein staining/OSDI. Future studies to establish a test with universally accepted cutoffs or a gold standard for OSD are increasingly necessary and highlight the unmet need of a large population suffering from OSD-related changes.