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Vol. 24, Art. 95 (pp. 1418-1437)    |    2023       

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Does the ocular surface change after surgical treatment of thyroid eye disease associated upper eyelid retraction

L.K. Anikina1, 2, S.Yu. Astakhov 1, V.V. Potemkin1,2, T.S. Varganova2, Sh.E. Babaeva1, S.A. Kostygina1, V.S. Prokopchuk1

1 Federal State Budgetary Educational Institution of Higher Education Academician I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russian Federation;197022, St. Petersburg, Lva Tolstogo St., 6-8;
2 St. Petersburg State Budgetary Healthcare Institution "City Multifunctional Hospital No. 2" 194354, St. Petersburg, Uchebny Pereulok, 5.

Brief summary

Upper eyelid retraction (UER) is the most common symptom of thyroid-associated ophthalmopathy (TAO). Patients suffer from dry eye syndrome, because of increased tear evaporation and elevated osmolarity, as well as reduced tear production. The study aims to assess the ocular surface condition, tear film parameters, and keratotopography indices before and after surgical treatment of TAO-associated UER. Materials and Methods. The study included patients with UER due to TAO. Inclusion criteria were inactive TAO, euthyroidism for at least 6 months, and upper eyelid retraction of 1 mm or more. All patients underwent transconjunctival orbital fat decompression at least 3 months before enrollment. Nine patients (13 eyes) with mild UER (mean UER 3.43?1.34 mm) underwent superior tarsal muscle extirpation (Group I), while the remaining 28 patients (45 eyes, mean UER 4.37?1.55 mm) underwent full-thickness blepharotomy with spacer implantation (the Alloplant? for eyelid reconstruction, Group II). Results. After six months of follow-up, both groups showed a statistically significant reduction in upper eyelid retraction (p<0.001) and palpebral fissure height (p<0.05), more pronounced in Group II. Both groups demonstrated a significant improvement in best-corrected visual acuity and quality of life. Group I exhibited decreased values in Schirmer's test 1 and Norn's test, while Group II showed changes in the LIPCOF test and a tendency towards decreased OSDI scores. However, objective measures of tear production did not reach statistical significance in either group. No significant changes in keratotopography indices were observed in both groups. Conclusion. Surgical treatment of upper eyelid retraction associated with thyroid-associated ophthalmopathy leads to an increase in best-corrected visual acuity and quality of life. Although there is a trend towards lower OSDI scores, surgical intervention does not significantly impact objective indicators of ocular surface and tear film condition.


Key words

thyroid eye disease, upper eyelid retraction, dry eye syndrome, ocular surface, keratotopografy

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