Symptoms and signs of dry eye in children with Graves' ophthalmopathy.

PURPOSE: The purpose of this study is to evaluate the tear secretion and ocular surface properties in children with Graves' ophthalmopathy (GO) and to compare the results with those of healthy children. METHODS: This was a cross-sectional study. Forty-three patients with GO (Group 1) and 41 healthy children without any ocular and/or systemic disorder (Group 2) were examined clinically and underwent tests for dry eye. We performed analyses including the Ocular Surface Disease Index (OSDI) questionnaire, Schirmer's test under topical anesthesia (<5 mm was abnormal), slit-lamp biomicroscopy (corneal fluorescein staining and tear breakup time (TBUT) under blue-light illumination), and fundoscopic evaluation. RESULTS: Dry eye symptoms and the mean OSDI score were significantly (P < 0.02) higher (15.6 ± 18.7) in patients with GO compared with controls (5.67 ± 3.6). The mean Schirmer's (basal tear secretion) tests value was significantly reduced in Group 1 (5.25 ± 3.1 mm) compared with Group 2 (17.1 ± 5.2), respectively. The difference was statistically significant (p < 0.005), suggesting inadequate tear production. The mean tear film breakup time in children was lower in patients with GO (8.3 ± 3.42 s,) compared with controls (13.2 ± 4.74 s), (P < 0.001) suggesting an unstable tear film. Decrease of corneal sensitivity (23.3%) was noted in patients with GO compared with controls. GO patients showed a significant increase of the frequency of corneal fluorescein staining (6.9%) in patients with GO compared with controls. CONCLUSION: Patients with GO had a statistically significant higher incidence of dry eye symptoms and the increase of OSDI score. Significantly lower Schirmer's and TBUT tests results were seen in the study group when compared with the controls. These findings may indicate a tendency for dry eye in pediatric GO patients.

The Influence of Juvenile Graves' Ophthalmopathy on Graves' Disease Course.

PURPOSE: To investigate juvenile Graves' ophthalmopathy (GO) signs and compare Graves' disease (GD) course in patients with or without GO. PATIENTS AND METHODS: There were analyzed data (visual acuity, proptosis, palpebral fissure measurements, clinical activity score (CAS), and the course of GD) of 67 children who have been newly diagnosed with GD. 26.9% of patients with GD had signs of ophthalmopathy (GO+), and 73.1% were without ophthalmopathy (GO-). RESULTS: Upper eyelid retraction (72.3%), proptosis (66.7%), and soft tissue changes (27.8-38.9%) were in GO+ patients. The palpebral fissure, CAS, and proptosis values were greater in the GO+ group than in the GO- group (p < 0.001). GD course in GO+ patients was longer than that in GO- patients (p < 0.001). The duration of the first remission was longer in GO- than in GO+ patients (p < 0.001). The duration of first remission was longer than one year for 61.2% in GO- and 33.3% in GO+ patients (p < 0.02). CONCLUSION: The common manifestations of juvenile GO patients were upper eyelid retraction, proptosis, and soft tissue involvement. The study demonstrates that pediatric patients with GO are more likely to have a severe course of autoimmune thyroid disease.

Predictive Factors of Development of Graves' Ophthalmopathy for Patients with Juvenile Graves' Disease.

Background. Due to low incidence of Graves' ophthalmopathy (GO) among children, the manifestation is poorly analyzed, posing a risk to late identification of insidious disease. Purposes. To identify predictive factors that may influence the development of GO in pediatric and young patients with Graves' disease (GD). Methods. A cross-sectional study of patients newly diagnosed with pediatric or juvenile GD during 2002-2012 was conducted at the Hospital of Lithuanian University of Health Sciences. Ocular evaluation was based on European Group on Graves' Orbitopathy survey. The ocular manifestations were analyzed in relation to demographic, environmental, and clinical factors. Results. In total, 130 patients with juvenile GD were included; 29.2% had GO. Median age at GD onset was 17 yrs (IQR 4-29). Main symptoms of GO were eyelids retraction (73.7%), proptosis (65.8%), injection of conjunctiva (42.1%), and eyeball motility disturbance (21.1%). Major significant and independent risk factors for GO development were high initial concentration of FT4 (OR = 5.963), TTHAb (OR = 6.358), stress (OR = 6.030), and smoking (OR = 7.098). Conclusion. The major factors that could influence GO development were smoking, stress, and increased levels of initial TRAb, FT4. Slight proptosis, retraction of eyelids, and conjunctive injection were found as predominant ophthalmological symptoms in juvenile GO.

Exophthalmometry value distribution in healthy Lithuanian children and adolescents.

PURPOSE: To determine absolute and relative ocular protrusion values for healthy Lithuanian children and adolescents and analyze the data according to the age, gender, weight, height, and outer orbital distance. METHODS: A total of 397 children and adolescents were included in this study. Measurements for the right and left eyes protrusions were done with Hertel exophthalmometer in healthy subjects aged from 5 to 18 years old. Height, weight, age and gender of subjects were recorded. RESULTS: The mean age for all children and adolescents was 11.5 ± 3.6 years. For all subjects, the mean (±SD) absolute ocular protrusion value of both eyes (OU) was 14.91 ± 1.68 mm. There was no significant difference in measurements between male and female subjects although female eye protrusion was higher. No individual had more than 2 mm of asymmetry between eyes. Mean exophthalmometric values for right eye were greater than the values of the left eye, and the mean relative protrusion for all participants was 0.2 mm. The mean distance between the lateral rims of the orbits was 98.7 ± 5.2 mm for all subjects. Proptosis measurements significantly correlated with the age, weight and height of children and adolescents and base measurements. CONCLUSIONS: In the present study, we have established ocular proptosis values according to the age, gender, weight and height of healthy Lithuanian children and adolescents. The eye protrusion significantly correlated with the age, weight and height of subjects and the distance between the lateral rims of the orbits. The gender did not play significant role on the eye projection data. We believe that larger, well-design studies are necessary in future to assess the distribution of proptosis in healthy Lithuanian children and adolescents.

Ultrasonic measurement of ocular rectus muscle thickness in patients with Graves' ophthalmopathy.

UNLABELLED: The aim of this study was to evaluate changes in extraocular muscle thickness and to assess its correlation with the degree of proptosis in patients with Graves' ophthalmopathy (GO). MATERIAL AND METHODS: A total of 242 patients (207 females and 35 males) with Graves' ophthalmopathy were enrolled into the study (GO group). Their mean age was 53.83±14.49 years. In addition, we examined an age-matched (53.51±12.79 years) control group of 40 healthy persons. All the participants underwent ophthalmological examination, including eye protrusion measurement and ultrasonographic evaluation of extraocular muscles thickness. RESULTS: The mean exophthalmos in the GO and control groups was 17.84±2.79 mm and 16.0±1.58 mm, respectively. The enlargement of inferior rectus muscle was recorded in 92.1% of patients, lateral rectus muscle in 81.2%, and medial rectus muscle in 50.8% (P<0.001). A significant correlation between exophthalmos and muscle thickness sum was found in the GO group (Spearman correlation coefficient, 0.515; P<0.0001). CONCLUSIONS: Graves' ophthalmopathy is more frequent in medium-aged women than men. A significant enlargement of inferior, lateral, and medial straight muscles was noticed in the GO group. With increasing proptosis, the sum of the muscle thickness was increasing, and exophthalmos moderately correlated with muscle thickness sum.

Changes of vision and refraction in patients with thyroid pathology.

OBJECTIVE: The aim of the study was to assess the relationship between thyroid pathology and visual acuity, including refraction disorders. MATERIAL AND METHODS: The data of visual acuity, refraction, and exophthalmos were analyzed, which were obtained from 105 patients with thyroid pathology. The data were compared with the findings of 23 healthy persons of similar age (control group). RESULTS: In case of thyroid pathology, visual acuity (right eye 0.71+/-0.035, left eye 0.73+/-0.045) was worse than in the control group (right eye 0.89+/-0.06, P<0.05; left eye 0.92+/-0.07, P<0.05). Myopia dominated in patients with thyroid pathology (refraction: right eye M 1.1+/-0.61 D, left eye M 1.0+/-0.64 D). In patients with exophthalmos of > or =17 mm, visual acuity was significantly worse (right eye 0.68+/-0.04, left eye 0.68+/-0.03) than in persons of the control group (right eye 0.89+/-0.06, P<0.05; left eye 0.92+/-0.07, P<0.05), and myopic refraction was found more frequently (right eye M 1.3+/-0.48 D, left eye M 1.3+/-0.56 D). Visual acuity was significantly better in patients when exophthalmos was <17 mm (right eye 0.80+/-0.05, P<0.05; left eye 0.80+/-0.05, P<0.05) than in cases when exophthalmos was > or =17 mm. CONCLUSIONS: Thyroid pathology and exophthalmos have an influence on visual acuity and refraction. In case of thyroid pathology, visual acuity appears to be worse than in the control group, and myopic refraction is more frequent. Visual acuity was found to be worse in patients with exophthalmos being > or =17 mm than in the control group, and myopic refraction was found to be more frequent.

Predicting outcome of treatment with radiotherapy in endocrine ophthalmopathy.

OBJECTIVE: To evaluate if the concentration of C-reactive protein and the level of antibodies to thyrotropin receptors might predict the outcome of retrobulbar irradiation in patients with endocrine ophthalmopathy. MATERIAL AND METHODS: Patients with moderate endocrine ophthalmopathy received orbital radiotherapy. The overall severity of endocrine ophthalmopathy was assessed using the total eye score based on the NOSPECS classification before the treatment and 6 months later. Treatment outcome was evaluated using major and minor criteria recommended by L. Bartalena 6 months after the treatment. Patients who improved in at least one major or in two or more minor criteria were considered responders. Patients in whom no changes occurred or who responded in only one minor criterion or eye status worsened were classified as nonresponders. The active disease was considered present in a patient who responded successfully to retrobulbar irradiation, and the inactive one when a patient did not respond. RESULTS: The level of antibodies to thyrotropin receptors in responders was 24.0 IU/L (range 2.0-405.0 IU/L) and in nonresponders 23.0 IU/L (range 2.0-405.0 IU/L); P=0.72. C-reactive protein levels in responders and nonresponders were 0.1 mg/L (range 0.1-3.1 mg/L) and 0.1 mg/L (range 0.1-1.5 mg/L), respectively; P=0.92. Although responders and nonresponders differed by proptosis, the severity of endocrine ophthalmopathy, and clinical activity score, but according to the binary logistic regression model, only the clinical activity score could give additional information on the prediction of the treatment outcome. If clinical activity score increased by 1, odds ratio for successful treatment outcome increased 2.4 times. CONCLUSIONS: 1) At the baseline of radiotherapy, the level of antibodies to thyrotropin receptors and concentration of C-reactive protein in responders did not differ from nonresponders; 2) Responders did not differ from nonresponders to radiotherapy by age, gender, duration of endocrine ophthalmopathy and thyroid disease; 3) The pretreatment clinical activity score, total eye score, proptosis of the responders were higher.

Investigations of ocular changes, extraocular muscle thickness, and eye movements in Graves' ophthalmopathy.

UNLABELLED: The aim of this study was to evaluate ocular changes, to measure the thickness of extraocular muscles, and to assess eye movements in patients with active Graves' ophthalmopathy. MATERIAL AND METHODS: We examined 27 patients (18 women and 9 men) with Graves' ophthalmopathy. Their age ranged from 17 to 59 years; mean age was 42.7+/-2.9 years. The control group consisted of 30 healthy persons aged 43.6+/-2.6 years. All patients underwent a complete ophthalmic examination including best-corrected Snellen visual acuity testing, measurements of proptosis using Hertel exophthalmometer, echography using A/B mode Mentor Advent ultrasonic diagnostic imaging system, ocular motility, slit-lamp and ophthalmoscopic examination. RESULTS: The examination showed a significant increase of proptosis, periorbital edema in 66.67%, chemosis in 59.26%, injection of conjunctiva in 45.15% of patients. The majority of patients with infiltrative form of Graves' ophthalmopathy had a significant enlargement of medial rectus muscle (from 5.0 to 5.9 mm in 46.3%, from 6.0 to 6.9 mm in 22.22% of eyes) and inferior rectus muscle thickness (from 5.0 to 5.9 mm in 33.33%, from 6.0 to 6.9 mm in 24.07% of eyes), disturbances in upward (less than 30 degrees in 62.96%) and lateral eye movements (from 30 to 50 degrees in 77.78%). CONCLUSIONS: The results of ocular examination showed an increase of proptosis, periorbital edema, chemosis and injection of conjunctiva in patients with Graves' ophthalmopathy. Ultrasound investigations showed a marked increase in the volume of medial and inferior eye muscle. In patients with Graves' ophthalmopathy, the changes in ocular motility (upward and lateral gaze) were detected.