title: Ocular surface and dry eye in Graves' disease.
abstract: OBJECTIVE
  To evaluate the tear function tests and the ocular surface damage in Graves' disease (GD) patients either with or without thyroid associated orbitopathy (TAO).
  
  
  METHODS
  Forty-two eyes of 21 randomly selected patients with GD, and 30 eyes of 15 healthy subjects were included in this prospective study. The presence of TAO was evaluated clinically. The palpebral fissure height, degree of proptosis, ocular surface disease index (OSDI), Schirmer tear test, tear break-up time (TBUT), and conjunctival impression cytology were assessed. The results were first compared between the patient and the control groups. Results were then compared between the patients with TAO (group I) and without TAO (group II).
  
  
  RESULTS
  The mean OSDI score in the patient group was 44.79 ± 11.83 and it was 21.17 ± 9.89 in the control group (p  =  0.001). The mean Schirmer tear test score was 14.4 ± 8.32 mm and 24.9 ± 3.57 mm in the patient and control group, respectively (p  =  0.001). The mean TBUT in the patient group was 7.1 sec. In the control group it was significantly increased to 10 sec (p  =  0.003). The mean proptosis and interpalpebral distance did not show any difference between the GD patients and controls (p > 0.05). The patients with GD showed significant ocular surface damage in which 75.71% had grade 2-3 squamous metaplasia in temporal interpalpebral conjunctiva. Twenty-four (57%) eyes composed group I. There were no differences in the mean OSDI score, Schirmer tear test score, TBUT, and the amount of ocular surface damage between group I and group II (p > 0.05).
  
  
  CONCLUSIONS
  Dry eye findings and the ocular surface damage in GD were most likely associated with the ocular surface inflammation. Before the development of the classic findings of TAO, ocular surface inflammation can be the only presenting clinical sign in GD.
authors.affiliation: Ankara Atatürk Training and Research Hospital, 2nd Ophthalmology Department, Ankara, Turkey. gurdalcm@yahoo.com
authors.forename: Canan
authors.initials: C
authors.lastname: Gürdal
authors.forename: Ozge
authors.initials: O
authors.lastname: Saraç
authors.forename: Ipek
authors.initials: I
authors.lastname: Genç
authors.forename: Hale
authors.initials: H
authors.lastname: Kırımlıoğlu
authors.forename: Tamer
authors.initials: T
authors.lastname: Takmaz
authors.forename: Izzet
authors.initials: I
authors.lastname: Can
mesh_terms: D000328:Adult; D003228:Conjunctiva / Q000473:pathology*; D015352:Dry Eye Syndromes / Q000175:diagnosis / Q000503:physiopathology*; D005260:Female; D049970:Graves Ophthalmopathy / Q000175:diagnosis / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008679:Metaplasia; D008875:Middle Aged; D009916:Orbital Diseases / Q000175:diagnosis / Q000503:physiopathology*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013666:Tears / Q000737:chemistry