Ocular surface and meibomian gland evaluation in euthyroid Graves’ ophthalmopathy

Abstract Purpose Euthyroid Graves’ ophthalmology (EGO) refers to the subgroup of thyroid eye disease patients with distinct clinical presentations. This study evaluated the ocular surface and meibomian gland changes in EGO patients. Methods A cross-sectional study was conducted at The Chinese University of Hong Kong including 34 EGO patients and 34 age-and sex- matched healthy controls. Outcome measures include anterior segment examination, keratographic and meibographic imaging. Results Between 34 EGO patients and 34 age and sex-matched healthy controls, EGO was associated with a higher ocular surface disease index ( P < 0.01), higher severity of meibomian gland dropout (upper: P < 0.001, lower: P < 0.00001) and higher percentage of partial blinking ( P = 0.0036). The worse affected eyes of the EGO patients were associated with corneal staining ( P = 0.0019), eyelid telangiectasia ( P = 0.0009), eyelid thickening ( P = 0.0013), eyelid irregularity ( P = 0.0054), meibomian gland plugging ( P < 0.00001), expressibility ( P < 0.00001), and meibum quality ( P < 0.00001). When the two eyes of the same EGO patient were compared, the degree of meibomian gland dropout was higher among the worse affected eyes (upper: P < 0.00001, and lower: P < 0.00001). Tear meniscus height, lipid layer thickness, and noninvasive break-up time were comparable between the two eyes of EGO patients and also between EGO patients and healthy controls. TMH was positively correlated with the degree of exophthalmos ( r = 0.383, P < 0.05). Conclusion EGO patients have more ocular surface complications and meibomian gland dropouts than healthy controls. Almost 60% of them had dry eye symptoms, but aqueous deficiency was not apparent. Further studies are warranted to clarify the mechanism of dry eye in EGO. (249 words).