Assessment of Inflammatory and Morphological Changes in the Conjunctival Cells in Relationship to the Degree of ProptosiS in Thyroid – Associated Ophthalmopathy

Abstract

Aim: to evaluate the inflammatory and morphological changes in conjunctival cells and the relationship to the degree of proptosis for helping early diagnosis of thyroid -associated eye disease. Subjects and methods: cross sectional observational prospective study that included 40 patients complain from proptosis of thyroid eye disease attended to Ain shams university, Cairo, from May 2019 to November 2020 with control 40 normal person. Exclusion criteria included patients with History of surgical correction of thyroid eye disease, auto immune disease, Previous Lasik surgery, recent Intraocular surgery, diabetic patients and patients under steroid or immune suppressive treatment. All patients were subjected to History taking of thyroid disease with laboratory investigations to assess the thyroid functions, visual acuity measurement, intraocular pressure, Hertel's exophthalmometry for measurement of the degree of proptosis, color vision using Ishihara’s test, Funds examination and Conjunctival impression cytology. Images were taken using an Olympus CX31 microscope fitted with an Olympus E-620 camera. Results: The degree of inflammation in impression cytology showed that most of thyroid eye disease group is in moderate degree (80%) 32 cases, while the rest (20%) is between mild degree of inflammation (15%) 6 cases and severe degree of inflammation (5%) 2 cases. No statistically significant relation found between degree of proptosis and severity of inflammation of right and left eye with p-value = 0.650 and 0.331 respectively. Morphologically, most of thyroid eye disease group showed stage 2 in impression cytology results (65%) 26 cases, while the rest (35%) between stage 4, 3, 1 (5%, 15%, 15%, respectively). Conclusion: Detection of inflammatory and morphological changes occurring in conjunctiva of cases with thyroid –associated Ophthalmopathy by impression cytology can help in early diagnosis of thyroid-associated Ophthalmopathy patients even before appearance of other eye symptoms.