SAT-513 Thyroid Disease And Infrared Imaging Of Eyelids

Abstract Background: Thyroid eye disease is thought to present as proptosis and/or severe conjunctival chemosis. Severe dry eye disease and its symptoms of non-specific eye pain and foreign body sensation in the eye can be overlooked as an early biomarker of thyroid disease. New infrared imaging can be used to evaluate dry eye and eyelid gland anatomy. Infrared imaging and detailed history of thyroid eye symptoms may lead to subsequent testing of thyroid function and more referrals to thyroid specialists. Purpose: Using infrared photography to evaluate dry eye complaints in patients: do they have thyroid disease? Methods: A retrospective chart review (2017–2019) of patients with dry eyes, eyelid imaging with infrared photography and thyroid lab testing was performed. Infrared photography with 820 nm wavelength (Heidelberg Spectralis, Heidelberg, Germany). Percentage loss of Meibomian glands was identified for each eye, then analyzed, per patient. The control population consisted of patients with no dry eye complaints, no thyroid testing or thyroid history. Exclusion criteria: patients over the age of 90 years and patients with a history of glaucoma, diabetes, cataract surgery, and eyelid surgery. Age matching was done (±5 years). Results: n=48 patients, avg age=57.73 years (sd=16.81, range 21–85 years). Thyroid patients: n=24 patients, male=10, female=14, avg age= 57.12 years (sd=16.65, med=55.5, range 23–83 years). Controls: n=24 patients, male=9, female=15, avg age=58.33 years (sd=17.30, med=58, range 21–85 years). Loss of Meibomian glands: thyroid=40.94%, control=5.10% (p<0.0001, t-test). Dry eye complaints: thyroid = 16/24, control = 0/24 (p<0.0001, x2). Discussion: Meibomian glands are glands in the upper and lower eyelids. These glands provide the lipid component of the tear film, thus slowing the evaporation of the tears and stabilizing the tear film with each blink. Meibomian gland loss would explain the dry eye symptoms in an abnormal thyroid patient population. Infrared photography can be performed with a #87 camera lens filter (cost = $65). The loss of Meibomian glands may be an early sign for thyroid disease. Conclusion: Infrared photography may be helpful in identifying severe dry eye, thus leading to increased awareness of thyroid eye disease symptoms in our patients in ophthalmology, endocrinology, and primary care.

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Intense Pulse Laser Therapy and Dry Eye Disease

10.5772/intechopen.99165 ◽

2021 ◽

Author(s):

Sana Niazi ◽

Farideh Doroodgar

Keyword(s):

Chronic Disease ◽

Dry Eye ◽

Management Strategies ◽

Tear Film ◽

Dry Eye Disease ◽

Eye Disease ◽

Second Phase ◽

Eye Symptoms ◽

Periocular Region ◽

New Treatment

The high and increasing prevalence of Dry Eye Disease (DED) highlights the need for new treatment treatments and more effective management strategies for this chronic disease. After training, lid grooming, and various ocular lubricants, the Tear Film & Ocular Surface Society Dry Eye Workshop II (TFOS DEWS II) Management and Therapy Subcommittee recently proposed Intense Pulsed Light (IPL) as the second phase of therapy. Brief flashes of non-coherent light (400–1,200 nm) are delivered to the skin’s surface using IPL technology. Toyos et al. found in 2005 that rosacea sufferers who were treated with IPL in the periocular region had a significant increase in their dry eye symptoms.

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MON-704 Tear Glands and the Diabetic Patient: Is It a Biomarker?

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.678 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Donia Momen ◽

Gloria Wu ◽

Shannon Luu ◽

Brian Leung

Keyword(s):

Dry Eye ◽

Infrared Imaging ◽

Tear Film ◽

Diabetic Patients ◽

Test Results ◽

Inclusion Criteria ◽

Corneal Surgery ◽

Percentage Loss ◽

Meibomian Glands ◽

Lab Test

Abstract Background: Tear glands in the eyelids, meibomian glands, play a role in tear film production and tear film stabilization. Diabetic patients often complain of dry eye and eye pain. Recently, there are new infrared (820nm) photography techniques to image meibomian glands easily in patients. Purpose: To study meibomian glands in diabetic patients with dry eye. Methods: A retrospective chart review (2017-2019) of Type 2 Diabetes Mellitus (T2DM) patients and non-diabetic patients with the diagnosis of “dry eye” in EHR (eClinicalworks, Westborough, MA) was performed. Infrared eyelid imaging (820 nm wavelength, Heidelberg Spectralis, Heidelberg, Germany) was taken. T2DM: Inclusion criteria: 1) HbA1c of > 5.7% who also had infrared eyelid imaging performed + 4 weeks of their HbA1c lab test results; 2) the percentage loss of meibomian glands for each eye, then averaged, for each patient. Control: Inclusion criteria: 1) non-diabetic patients; 2) HbA1c lab test results; 3) infrared eyelid imaging was performed; 4) percentage loss of meibomian glands was calculated for each eye, then averaged per patient. Exclusion criteria for both T2DM and Controls: younger than the age of 18 years old, older than 90 years old, no glaucoma topical medications, no eyelid surgery, no corneal surgery, no conjunctival surgery. Results: n=120 patients, Avg Age=69.6 years (sd=15.1, range 23-89 years). Diabetic patients: n=60 patients, Male=30, Female=30, Avg Age=65.1 years (sd=11.50, med=65.5, range 36-85 years). Controls: n=60 patients, Male=37, Female=23, Avg Age=54.1 years (sd=16.4, med=56.5, range 23-89 years). Meibomian gland loss: Diabetics=51.54%, Controls=11.29% (p<0.0001, t-test). Of the 60 DM patients: 35/37pts with HbA1c > 6.6% had greater loss of meibomian glands (>40%), compared to 12/23 DM patients with HbA1c < 6.5%, p=0.0001. Discussion: Loss of meibomian glands in diabetic patients have been recently investigated; however, its relationship to HbA1c as a possible biomarker has not been widely discussed in literature. In this small study, loss of meibomian glands occur more frequently with elevated HbA1c, perhaps due to microischemia of the eyelids, thereby resulting in loss of meibomian glands. Conclusion: Loss of meibomian glands may suggest a need for HbA1c testing and further monitoring of the patient’s diabetic condition. Infrared imaging of the eyelid may be useful in characterizing dry eye in diabetic patients.

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Review of the Literature on Existing Management of Dry Eye Disease

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i60a34561 ◽

2021 ◽

pp. 878-884

Author(s):

Isha Chandrakar ◽

Shruti Sanghavi

Keyword(s):

Dry Eye ◽

Contact Lenses ◽

Antibacterial Properties ◽

Tear Film ◽

Severe Case ◽

Dry Eye Disease ◽

Eye Disease ◽

Lacrimal Glands ◽

Ocular Symptoms ◽

Meibomian Glands

Dry eye disease (DED) is a multifactorial disease in which the tear film’s homeostasis is lost, along with other ocular symptoms such as tear film instability and high osmolarity, neurosensory abnormalities, and ocular surface inflammation and damage. DED is a condition of lacrimal apparatus which is responsible for tear production. The tear film is a mixture of mucin, aqueous (water and solutes like NacI, sugar, urea, proteins,), lipids secreted by goblet cells, lacrimal glands, and meibomian glands, respectively. It keeps the eye moist, provides oxygen to the cornea, and has antibacterial properties. The lipid layer prevents the evaporation of the aqueous. DED is categorized into (i)Aqueous-tear deficiency, characterized by a deficiency of lacrimal glands to secrete tears, (ii)Evaporative DED, associated with increased tear loss by evaporation because there is a deficiency of the meibomian glands. The mechanism of DED might be loss of tear through evaporation or insufficient aqueous production or a combination of the two. DED is a widespread eye problem, which is often left untreated. It causes irritation, itching, dryness, foreign body sensation, and discomfort; severe case causes conjunctival congestion, keratinization, erosion of the corneal epithelium, and plaque formation. If left Univision- threatening vision-threatening, leading to complications like corneal ulceration and perforation. Various clinical tests are used to diose DED, including tear breakup time, tear osmolarity, Schirmer test, Rose Bengal staining, and expression of inflammatory markers. There is no cure for DED at present. The following modalities are used for its treatment: use of punctual and canalicular plugs, artificial tear products like polyethylene glycol/propylene glycol with guar HP, consuming food rich in omega-three fatty acids, antioxidants zeaxanthin, and lutein, Use of anti-inflammatory drugs, mucolytics, secretagogues. Reducing or avoiding mild risk factors like prolonged reading, prolonged use of contact lenses, excessive screen time, etc. Treatment of causative disease. Appropriate management and establishing reasonable patient expectations are necessary to ensure patient satisfaction and adherence to the treatment.

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Natural history of inflammatory and non-inflammatory dry eye in thyroid eye disease

Orbit ◽

10.1080/01676830.2020.1814352 ◽

2020 ◽

pp. 1-5

Author(s):

Christopher Lo ◽

Michael Yang ◽

Daniel Rootman

Keyword(s):

Natural History ◽

Dry Eye ◽

Thyroid Eye Disease ◽

Eye Disease ◽

History Of

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Occult Thyroid Eye Disease in Patients Presenting with Dry Eye Symptoms

American Journal of Ophthalmology ◽

10.1016/j.ajo.2008.12.007 ◽

2009 ◽

Vol 147 (5) ◽

pp. 919-923 ◽

Cited By ~ 52

Author(s):

Anita Gupta ◽

Pooyan Badihian Sadeghi ◽

Esen Karamursel Akpek

Keyword(s):

Dry Eye ◽

Thyroid Eye Disease ◽

Eye Disease ◽

Eye Symptoms ◽

Dry Eye Symptoms

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Tear film break-up patterns in thyroid eye disease

Scientific Reports ◽

10.1038/s41598-021-84661-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yasuhiro Takahashi ◽

Patricia Ann L. Lee ◽

Aric Vaidya ◽

Shinjiro Kono ◽

Hirohiko Kakizaki

Keyword(s):

Observational Study ◽

Dry Eye ◽

Diagnostic Method ◽

Prospective Observational Study ◽

Tear Film ◽

Thyroid Eye Disease ◽

Eye Disease ◽

The Status ◽

Surface Damages ◽

Break Up

AbstractEvaluation of tear film break-up pattern (TFBUP) is the main diagnostic method for tear film-oriented therapy (TFOT) of dry eye. This prospective, observational study examined TFBUPs in 154 eyes/sides from 78 patients with thyroid eye disease (TED) who met the diagnostic criteria for dry eye in Japan. TFBUPs were classified as area, line, spot, dimple, and random breaks. Results for the status of TED and dry eye were compared between the TFBUPs. Consequently, line, spot, dimple, and random breaks were observed in 80 (51.9%), 29 (18.8%), 10 (6.5%), and 35 eyes (22.7%) while no eyes showed area breaks. The random break group had the highest incidence of lid lag/Graefe sign and superior limbic keratoconjunctivitis (SLK) (P < 0.050). Although the incidence of each TFBUP is almost equal in patients with simple dry eye without TED, line breaks were more frequently observed in TED. In addition, while random breaks in simple dry eye are usually only associated with minor ocular surface damages, those in TED were associated with a higher incidence of concomitant SLK. These results will be helpful for understanding the etiology of dry eye in TED and for TFOT in TED.

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Dry eye disease and its treatment in women over 45 years

Clinical ophthalmology ◽

10.32364/2311-7729-2021-21-2-103-107 ◽

2021 ◽

Vol 21 (2) ◽

pp. 103-107

Author(s):

E.A. Drozdova ◽

◽

V.E. Balan ◽

Keyword(s):

Dry Eye ◽

Tear Film ◽

Meibomian Gland ◽

Dry Eye Disease ◽

High Rate ◽

Eye Disease ◽

Lipid Layer ◽

Age Related ◽

Meibomian Glands ◽

Nano Emulsion

Epidemiological studies demonstrate an increase in age-related prevalence of dry eye disease (DED) and its higher occurrence in women. In addition to age-related alterations of structures producing tear film, the reduction of androgen levels and other regulating hormones is important for DED development. The role of estrogens and progesterone in the regulation of lacrimal and meibomian gland activity is still disputable. Additional factors of DED development in women are a high rate of comorbidities affecting gland functions, use of cosmetics and cosmetic procedures, contact lens wearing. The results are partial atrophy of meibomian glands, changes in the quality and amount of their secret, increased tear evaporation. Cationic nano-emulsion that addresses the deficiency and stabilize the lipid layer, increases water content, and reduces tear osmolarity is recommended for DED in women. Keywords: dry eye disease, tear film, meibomian glands, postmenopausal, lipid layer, tear osmolarity, artificial tears, cationic nano-emulsion. For citation: Drozdova E.A., Balan V.E. Dry eye disease and its treatment in women over 45 years. Russian Journal of Clinical Ophthalmology. 2021;21(2):103–107. DOI: 10.32364/2311-7729-2021-21-2-103-107.

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Tear Proteomics Study of Dry Eye Disease: Which Eye Do You Adopt as the Representative Eye for the Study?

International Journal of Molecular Sciences ◽

10.3390/ijms22010422 ◽

2021 ◽

Vol 22 (1) ◽

pp. 422

Author(s):

Ming-Tse Kuo ◽

Po-Chiung Fang ◽

Shu-Fang Kuo ◽

Alexander Chen ◽

Yu-Ting Huang

Keyword(s):

Dry Eye ◽

Ocular Surface ◽

Tear Film ◽

Dry Eye Disease ◽

Eye Disease ◽

Mechanistic Studies ◽

Clinical Tests ◽

Tear Proteins ◽

Proteomic Data ◽

Surface Performance

Most studies about dry eye disease (DED) chose unilateral eye for investigation and drew conclusions based on monocular results, whereas most studies involving tear proteomics were based on the results of pooling tears from a group of DED patients. Patients with DED were consecutively enrolled for binocular clinical tests, tear biochemical markers of DED, and tear proteome. We found that bilateral eyes of DED patients may have similar but different ocular surface performance and tear proteome. Most ocular surface homeostatic markers and tear biomarkers were not significantly different in the bilateral eyes of DED subjects, and most clinical parameters and tear biomarkers were correlated significantly between bilateral eyes. However, discrepant binocular presentation in the markers of ocular surface homeostasis and the associations with tear proteins suggested that one eye’s performance cannot represent that of the other eye or both eyes. Therefore, in studies for elucidating tear film homeostasis of DED, we may lose some important messages hidden in the fellow eye if we collected clinical and proteomic data only from a unilateral eye. For mechanistic studies, it is recommended that researchers collect tear samples from the eye with more severe DED under sensitive criteria for identifying the more severe eye and evaluating the tear biochemical and proteomic markers with binocular concordance drawn in prior binocular studies.

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