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.

Evaluation of the outcomes following endonasal endoscopic orbital decompression in patients with Graves' ophthalmopathy / Evaluación de los resultados después de la descompresión orbital endonasal endoscópica en pacientes con oftalmopatía de Graves

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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.