title: Topical rebamipide treatment for superior limbic keratoconjunctivitis in patients with thyroid eye disease.
abstract: OBJECTIVE
  To evaluate efficacy of topical rebamipide for superior limbic keratoconjunctivitis (SLK) in patients with thyroid eye disease.
  
  
  METHODS
  Retrospective, observational case series.
  
  
  METHODS
  Thirty-three eyes from 20 thyroid eye disease patients with SLK who received topical rebamipide (Mucosta ophthalmic suspension unit dose 2%; Otsuka Pharmaceutical Co, Ltd; chemical name, (2RS)-2-(4-chlorobenzoylamino)-3-(2-oxo-1, 2-dihydroquinolin-4-yl) propanoic acid) were included. The following items were evaluated before and 4 weeks after the start of treatments: presence or absence of SLK, rose bengal staining score, area and density classification of fluorescein staining, Schirmer test I results (without topical anesthesia), tear film break-up time, Hertel exophthalmometry values, and margin reflex distances 1 and 2.
  
  
  RESULTS
  Twenty-eight eyes showed complete disappearance of SLK after treatment (84.8%; P < .001). The other 5 eyes (15.2%) demonstrated significant improvement, but had residual punctate rose bengal staining and fluorescein staining near the superior corneal limbus. All 5 eyes exhibited at least 1 of the following findings: proptosis of more than 17.7 mm and upper or lower eyelid retractions or both. Incidence of upper eyelid retraction was significantly higher in eyes with SLK than in those without SLK at the 4-week follow-up (P = .021). The severity of rose bengal staining and fluorescein staining improved significantly after treatment (P < .001). Although the Schirmer test results remained constant before and after the treatment (P = .212), tear film break-up time increased significantly in the posttherapeutic state (P = .009). No serious adverse events were reported.
  
  
  CONCLUSIONS
  Topical rebamipide improved SLK in patients with thyroid eye disease, suggesting a first-line treatment in such patients.
authors.affiliation: Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Takahashi
authors.affiliation: Department of Plastic Surgery, Kobe University School of Medicine, Kobe, Hyogo, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Ichinose
authors.affiliation: Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan. Electronic address: cosme@d1.dion.ne.jp.
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Kakizaki
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000409:Alanine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000975:Antioxidants / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D019793:Fluorescein; D005456:Fluorescent Dyes; D049970:Graves Ophthalmopathy / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D007637:Keratoconjunctivitis / Q000175:diagnosis / Q000188:drug therapy*; D016850:Limbus Corneae / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions; D009994:Osmolar Concentration; D015363:Quinolones / Q000008:administration & dosage / Q000627:therapeutic use*; D012189:Retrospective Studies; D012395:Rose Bengal; D013666:Tears / Q000737:chemistry; D016896:Treatment Outcome
chemical_list: D000975:Antioxidants; D005456:Fluorescent Dyes; D009883:Ophthalmic Solutions; D015363:Quinolones; D012395:Rose Bengal; C052785:rebamipide; D000409:Alanine; D019793:Fluorescein