Abstract
The aim of this prospective observational study was to examine changes in eyelid pressure and dry eye status after orbital decompression in thyroid eye disease (TED). In 16 patients (29 sides), upper eyelid pressure at plateau phase and maximum pressure were measured. TED status was evaluated through the Hertel exophthalmometric value and margin reflex distance (MRD)-1 and 2. Dry eye status was quantified through corneal fluorescein staining, tear break-up time, Schirmer test I results, meibomian gland dysfunction (MGD), tear meniscus height, and superior limbic keratoconjunctivitis (SLK). Patients were classified into two groups: patients with decreased eyelid pressure (Group 1) and those with elevated pressure (Group 2). Consequently, neither the maximum upper eyelid pressure nor pressure at plateau phase significantly changed after surgery (p > 0.050). Some parameters about MGD improved after surgery, but the other parameters on dry eye, MGD, and SLK worsened or did not change. MRD-1 decreased more (p = 0.028), and the ratio of patients in whom SLK improved after surgery was larger in Group 1 (p = 0.030). These results indicate that upper eyelid pressure tends to decrease postoperatively in patients with a high upper eyelid position, resulting in improvement of SLK.
Highlights
The eyelid pressure is regulated by the eyelid tension and anterior eye position [1]
Neither the maximum upper eyelid pressure nor upper eyelid pressure at the plateau phase significantly changed after orbital decompression (p > 0.050)
The ratio of patients with and without superior limbic keratoconjunctivitis (SLK) did not change after orbital decompression (p = 1.000)
Summary
The eyelid pressure is regulated by the eyelid tension and anterior eye position [1]. In thyroid eye disease (TED), an enlarged and cicatricial levator palpebrae superioris produces a taut upper eyelid as well as upper eyelid retraction [2,3]. Previous experimental studies showed that tension of the eyelid in the anterior direction increases eyelid tension [5,6]. A high eyelid pressure can cause abnormal friction between the ocular surface and palpebral conjunctiva [2]. This increases concentration of inflammatory cytokines and induces local mucin deficiency in the ocular surface [2,7,8], resulting in dry eye and superior limbic keratoconjunctivitis (SLK) in TED
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