Ocular Surface Disease Related to the Inflammatory and Non-Inflammatory Phases of Thyroid Eye Disease

Cinthia Minatel Riguetto,1,* Eduardo Buzolin Barbosa,2,* Camila Cristina Atihe,2 Fabiano Reis,3 Mônica Alves,2 Denise Engelbrecht Zantut-Wittmann1 1Endocrinology Division, Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas, São Paulo, Brazil; 2Department of Ophthalmology and Otorhinolaryngology, Faculty of Medical Sciences, University of Campinas, São Paulo, Brazil; 3Department of Radiology, Faculty of Medical Sciences, University of Campinas, São Paulo, Brazil*These authors contributed equally to this workCorrespondence: Denise Engelbrecht Zantut-Wittmann, Endocrinology Division, Department of Internal Medicine, Faculty of Medical Sciences – University of Campinas, Rua Tessália Vieira de Camargo, 126, Campinas, São Paulo, 13084-971, Brazil, Tel +55 19 32894107, Email zantutw@unicamp.brPurpose: This study evaluated the ocular surface disease (OSD), especially dry eye disease (DED) parameters by combining qualitative and quantitative tools, including tear matrix metalloproteinase 9 (MMP-9), in patients with Graves’ disease (GD) with and without Thyroid eye disease (TED).Patients and Methods: A total of 17 active TED, 16 inactive TED, 16 GD without ophthalmopathy, and 16 healthy controls were included. All patients were assessed with CAS, ophthalmometry, qualitative tear MMP-9, Ocular Surface Disease Index (OSDI), ocular surface staining, Schirmer test, meibography, tear meniscus height, conjunctival hyperemia, and non-invasive tear film break-up time. Patients were classified into three subtypes of DED: aqueous tear deficiency, meibomian gland dysfunction (MGD) and mixed dry eye.Results: Inactive TED was shown to be an associated factor with DED (odds ratio 14, confidence interval 2.24– 87.24, p=0.0047), and presented more DED than healthy controls (87.5% versus 33.3%, p=0.0113). MGD was also more prevalent among these subjects than in healthy control (62.5% versus 6.7%; p=0.0273). No significant d