title: Ocular surface changes in thyroid eye disease.
abstract: OBJECTIVE
  To study the incidence and risk factors of ocular surface damage in thyroid eye disease (TED) and to determine histological changes underlying positive vital staining in this condition.
  
  
  METHODS
  Forty-six patients (92 eyes) with TED were included in this study. Routine ophthalmologic examination, Schirmer test I, vital staining and corneal sensitivity were performed. Fifteen patients with positive vital staining underwent impression cytology and incisional biopsy.
  
  
  RESULTS
  Positive vital staining with lissamine green was observed in 56 eyes (60.9%), 30 patients (65.2%). The average degree of staining was 4.57 ± 0.44 (National Eye Institute Workshop grading system). Severe dry eye syndrome was found in 16%. The following histological changes of conjunctiva were revealed: significant epithelial dystrophy with cell polymorphism, goblet cells loss, excessive desquamation and epithelial keratinization with local leukocytic infiltration of substantia propria.
  
  
  CONCLUSIONS
  According to our results dry eye syndrome is present in 65.2% of patients (60.9% eyes) with TED. Significant risk factors of ocular surface damage in TED were exophthalmos, lagophthalmos, palpebral fissure height and lower lid retraction. Positive conjunctival staining results from punctuate epithelial erosions and excessive desquamation of superficial cells. Histopathologic changes detected in conjunctiva consistent with dry eye and are not specific for TED.
authors.affiliation: Institute of Eye Diseases of Russian Academy of Medical Sciences, Moscow, Russian Federation. d_ismailova@bk.ru
authors.forename: Dilyara S
authors.initials: DS
authors.lastname: Ismailova
authors.forename: Anatoly A
authors.initials: AA
authors.lastname: Fedorov
authors.forename: Yaroslav O
authors.initials: YO
authors.lastname: Grusha
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D002467:Cell Nucleus / Q000473:pathology; D048430:Cell Shape; D003229:Conjunctival Diseases / Q000175:diagnosis*; D003593:Cytoplasm / Q000473:pathology; D015352:Dry Eye Syndromes / Q000175:diagnosis*; D004847:Epithelial Cells / Q000473:pathology*; D005260:Female; D020397:Goblet Cells / Q000473:pathology; D049970:Graves Ophthalmopathy / Q000175:diagnosis*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D055815:Young Adult