title: Pediatric thyroid eye disease--the Singapore experience.
abstract: OBJECTIVE
  To identify the demographics, risk factors, clinical manifestations and treatment methods of pediatric thyroid eye disease (TED) in a South-East Asian tertiary referral practice.
  
  
  METHODS
  Retrospective case series of all pediatric patients (aged 18 years and under) who presented to our TED clinic between Jan 2006 and Dec 2012.
  
  
  RESULTS
  Thirteen patients (26 eyes) were identified - 8 females (61.5%) and 5 males (38.5%), accounting for 6.2% of all TED patients in our practice. Median age was 10.0 years (range, 0.3-18.0). Positive family history was noted in 9 patients (69.2%) and there were no active/passive smokers. Mean follow-up duration was 1.81 years (range, 0-5.2). Common presenting signs included proptosis (92.3%), eyelid retraction (84.6%), acquired epiblepharon (69.2%), corneal erosion (53.8%), and lagophthalmos (53.8%). None had optic neuropathy or strabismus. Mean exophthalmometry was 17.8 mm (SD ± 3.6 mm, range 13.0-27.0). Ten patients (76.9%) had mild disease, 3 patients (23.1%) had moderate disease and none had severe disease. Clinically significant Active disease as defined in adults (VISA Inflammatory Score >4/10), was not observed in any patient. The majority of the patients were treated conservatively. One patient underwent bilateral orbital decompression for severe proptosis, while two patients underwent bilateral lower epiblepharon correction with good outcomes. None required corticosteroids (oral/pulsed).
  
  
  CONCLUSIONS
  Clinical manifestations in pediatric TED are relatively mild and respond well to conservative therapy. Orbital decompression is rarely required but may be considered in children with severe proptosis. Mean exophthalmometry values are lower in East-Asian pediatric TED as compared to Caucasians. Symptomatic acquired epiblepharon, usually associated with keratopathy, is commonly seen in East-Asian pediatric TED; thus, increased awareness among ophthalmologists and pediatricians should be emphasized.
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, National University Health System , Singapore and.
authors.forename: Nigel Chen Siang
authors.initials: NC
authors.lastname: Lim
authors.forename: Shantha
authors.initials: S
authors.lastname: Amrith
authors.forename: Gangadhara
authors.initials: G
authors.lastname: Sundar
mesh_terms: D000293:Adolescent; D044466:Asian People; D002648:Child; D002675:Child, Preschool; D019299:Decompression, Surgical; D003941:Diagnostic Techniques, Ophthalmological; D005141:Eyelid Diseases / Q000151:congenital / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D005143:Eyelids / Q000002:abnormalities; D005260:Female; D049970:Graves Ophthalmopathy / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology