[Evaluation of ocular surface status and function in primary Sjögren's syndrome with hypothyroidism].

OBJECTIVE: To explore the effect of hypothyroidism (HT) on the ocular surface status of patients with primary Sjögren's syndrome-related dry eye (pSS-DED). METHODS: The cross-sectional study included 36 patients with pSS-DED who were treated at the dry eye clinic of Peking University Third Hospital from December 2020 to June 2021, of whom 12 were pSS-DED patients combined with HT. In the same period, 24 patients with simple dry eye disease (DED) were served as a control group. All the patients filled out the Ocular Surface Disease Index (OSDI) questionnaire, and performed tear film break-up time (BUT), Schirmer test, tear meniscus height, corneal/conjunctival fluorescein staining, meibomian gland secretion capacity, meibum evaluation and confocal microscope examination. RESULTS: (1) Compared with pSS-DED and simple DED patients, pSS-DED +HT patients had lower average BUT [(2.7±0.8) s], Schirmer test [(4.9±4.8) mm] and tear meniscus height [(0.13±0.03) mm], and the difference was statistically significant (F=12.43, P < 0.01; F=6.96, P < 0.01; F=3.31, P < 0.05). (2) Compared with DED and pSS-DED patients, the meibomian gland secretion capacity and meibomian trait scores of pSS-DED+HT patients were mainly distributed in the high division. There were statistically significant differences in the distribution of secretion capacity of meibomian glands (χ2=10.72, P < 0.05) and meibomian trait assessment scores (χ2=8.34, P < 0.05) among the three groups. (3) Serum total thyroxine and serum free thyroxine levels in the pSS-DED+HT patients showed positive correlation (P < 0.05, P < 0.05) with their BUT (r=0.60, 0.60), Schirmer's test (r=0.64, 0.66) and tear river height (r=0.61, 0.62), independent of lid gland secretory capacity; no significant correlation was found between thyroid-stimulating hormone, anti-thyroglobulin antibody and lid gland secretory capacity. Thyroid hormone, anti-thyroglobulin antibody, and thyroid peroxidase antibody were not found to be significantly correlated with ocular surface status. (4) Compared with pSS-DED, the fiber density of the subbasal nerve plexus in pSS-DED+HT group decreased (t=2.06, P < 0.05), and the curvature score increased (t=2.13, P < 0.05). CONCLUSION: The ocular surface condition of pSS-DED patients with HT is worse than that of pSS-DED and DED patients. The main manifestations are that tear secretion, tear film stability, secretory function of the meibomian glands, meibum trait and fiber density of the subbasal nerve plexus decrease while the curvature increases. The mechanism might be related to the decrease in thyroid hormone production.

An investigation into the effects of ocular nebulization combined with meibomian gland massage on ocular surface status and corneal higher-order aberrations for the treatment of meibomian gland dysfunction.

PURPOSE: To evaluate ocular surface status and corneal higher-order aberrations after a new ocular nebulization therapy combined with meibomian gland massage for the treatment of meibomian gland dysfunction (MGD). PATIENTS AND METHODS: This prospective randomized study involved 38 patients diagnosed with MGD. Subjects were classified into two groups: the nebulization and meibomian gland massage group (or NB group, 14 patients, 28 eyes) and the eye drop group (or ED group, 24 patients, 48 eyes). Azithromycin solution and esculin and digitalis glycoside eye drops were tested in the therapy. Best-corrected visual acuity (BCVA) testing; noncontact tonometry; fundoscopy; the Ocular Surface Disease Index (OSDI) questionnaire; tear film assessment encompassing tear meniscus height (TMH) and non-invasive keratograph breakup time (NIKBUT); corneal fluorescein staining; the Schirmer I test (SIT); and anterior, posterior and total corneal aberrations were evaluated at 1 and 3 months after treatment. RESULTS: At 3 months, the NB group showed significantly better improvement than the ED group in terms of TMH (0.23 ± 0.04 versus 0.19 ± 0.05, p = 0.002) and first breakup time (f-BUT; 7.42 ± 2.49 versus 5.53 ± 2.12, p = 0.001). The average breakup time (Av-BUT) of the NB group was significantly longer than that of the ED group at 1 month (9.52 ± 2.70 versus 8.02 ± 2.33, p = 0.013) and 3 months (5.53 ± 2.12 versus 8.35 ± 2.38, p = 0.018). Both groups achieved improvement in corneal fluorescein staining (CFS) and SIT results at 1 and 3 months (p < 0.05). At the 3-month follow-up, anterior corneal trefoil aberrations decreased significantly in the NB group (p = 0.008), and improvements in anterior corneal coma aberrations and posterior corneal higher-order aberrations (HOAs) were observed in the ED group (p < 0.05) over the 4 mm pupil zone. Over a 6 mm zone at 3 months, anterior, posterior and total trefoil aberrations as well as total HOAs were significantly decreased in the NB group (p < 0.05), while posterior HOAs and trefoil aberrations were found to be decreased in the ED group (p < 0.05). For individual Zernike terms, anterior and total corneal Z(3, -3) showed decreases over the 4 and 6 mm zones, while no improvement was detected in the NB group at 3 months. CONCLUSION: In terms of comfort and visual quality, nebulization therapy combined with meibomian gland massage to deliver azithromycin solution and esculin and digitalis glycoside eye drops appears to be more effective in treating clinical symptoms and signs of MGD than simply applying esculin and digitalis glycoside eye drops.

Comparison of Changes in Ocular Surface Status after Wearing Orthokeratologic and Rigid Gas Permeable Lens

PURPOSE: To evaluate the differences in dry eye and meibomian gland dysfunction (MGD) by comparing ocular surface status before and after wearing an orthokeratologic (OK) lens and rigid gas permeable (RGP) lens made of the same material. METHODS: The ocular surface and meibomian gland statuses of 12 eyes of 12 OK lens wearers (OK lens group) and 16 eyes of 16 RGP wearers (RGP lens group) were evaluated before and 1 and 3 months after lens wearing. Ocular surface disease index (OSDI), tear film break-up time (TBUT), Schirmer's test I, and ocular surface staining score were evaluated for ocular surface parameters. Meibomian gland function was evaluated by assessing lid margin abnormality, meibomian gland expressibility, and meibum quality. RESULTS: TBUT and ocular surface staining score after 1 and 3 months of wearing an OK lens were significantly aggravated (p= 0.004, p < 0.001). The MGD grade, lid margin abnormality, meibomian gland expressibility, and meibum quality were aggravated after 1 and 3 months of wearing an OK lens (p < 0.001, p < 0.001, p < 0.001, p= 0.002). After 1 and 3 months of wearing an RGP lens, OSDI, TBUT, and ocular surface staining score were aggravated (all p < 0.001). The MGD grade, lid margin abnormality, meibomian gland expressibility, and meibum quality were aggravated after 1 and 3 months of wearing an RGP lens (all p < 0.001). MGD grade, lid margin abnormality, meibomian gland expressibility, and meibum quality were significantly more aggravated in the RGP lens group than in the OK lens group after 3 months (p < 0.001, p < 0.001, p= 0.001, p < 0.001). CONCLUSIONS: Use of OK and RGP lenses affects ocular surface status. Especially, meibomian gland parameters and OSDI showed greater changes in RGP lens wearers than OK lens wearers.

Comparison of Changes in Ocular Surface Status after Wearing Orthokeratologic and Rigid Gas Permeable Lens

PURPOSE: To evaluate the differences in dry eye and meibomian gland dysfunction (MGD) by comparing ocular surface status before and after wearing an orthokeratologic (OK) lens and rigid gas permeable (RGP) lens made of the same material. METHODS: The ocular surface and meibomian gland statuses of 12 eyes of 12 OK lens wearers (OK lens group) and 16 eyes of 16 RGP wearers (RGP lens group) were evaluated before and 1 and 3 months after lens wearing. Ocular surface disease index (OSDI), tear film break-up time (TBUT), Schirmer's test I, and ocular surface staining score were evaluated for ocular surface parameters. Meibomian gland function was evaluated by assessing lid margin abnormality, meibomian gland expressibility, and meibum quality. RESULTS: TBUT and ocular surface staining score after 1 and 3 months of wearing an OK lens were significantly aggravated (p= 0.004, p < 0.001). The MGD grade, lid margin abnormality, meibomian gland expressibility, and meibum quality were aggravated after 1 and 3 months of wearing an OK lens (p < 0.001, p < 0.001, p < 0.001, p= 0.002). After 1 and 3 months of wearing an RGP lens, OSDI, TBUT, and ocular surface staining score were aggravated (all p < 0.001). The MGD grade, lid margin abnormality, meibomian gland expressibility, and meibum quality were aggravated after 1 and 3 months of wearing an RGP lens (all p < 0.001). MGD grade, lid margin abnormality, meibomian gland expressibility, and meibum quality were significantly more aggravated in the RGP lens group than in the OK lens group after 3 months (p < 0.001, p < 0.001, p= 0.001, p < 0.001). CONCLUSIONS: Use of OK and RGP lenses affects ocular surface status. Especially, meibomian gland parameters and OSDI showed greater changes in RGP lens wearers than OK lens wearers.