title: Thyroid eye disease: a Southeast Asian experience.
abstract: OBJECTIVE
  To study the demographics, comorbidities, clinical manifestations and treatment methods of thyroid eye disease (TED) in Singapore.
  
  
  METHODS
  In this retrospective case series, we analysed the case records of all patients with TED who presented at our multidisciplinary Thyroid Eye Clinic from November 2002 to October 2012.
  
  
  RESULTS
  There were a total of 174 patients-111 female patients (63.8%) and 63 male patients (36.2%). The majority of the patients were ethnically Chinese (80.5%), followed by Malay (10.3%) and Indian (6.3%). The mean age was 40.2 years (SD±15.5, range 0.3-87.0). The commonest sign on ophthalmic examination was eyelid retraction (62.1%), followed by proptosis (61.0%) and lid lag (57.5). Acquired epiblepharon and corneal erosions were noted in 11.5% and 29.3% respectively. Eight patients (4.6%) had dysthyroid optic neuropathy. The mean exophthalmometry reading was 18.8 mm (SD±3.32, range 10.0-28.0). Mild, moderate and severe disease was noted in 71.3%, 20.7% and 8.0% respectively. Thyroid dysfunction was managed with anti-thyroid medication only (40.2%), β blockers (19.5%), thyroxine replacement (14.4%), radioactive iodine (14.4%) and block-replace regime (9.8%). Clinically significant active orbitopathy was managed with intravenous corticosteroids (12.1%). Surgical procedures consisted of thyroidectomy (10.3%), eyelid surgery (8.6%), orbital decompression (7.5%), epiblepharon correction (2.3%) and strabismus surgery (0.6%).
  
  
  CONCLUSIONS
  Corneal erosion secondary to acquired epiblepharon is a common sign in East Asian patients with TED, thus increased awareness among physicians should be encouraged. Mean exophthalmometry values and frequencies of upper eyelid retraction and oedema are lower in East Asian patients compared with Caucasian patients. Among Singapore's multi-ethnic population, Malay patients with TED had the highest exophthalmometry reading.
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore.
authors.forename: Nigel C S
authors.initials: NC
authors.lastname: Lim
authors.affiliation: Orbit & Oculofacial Surgery, Department of Ophthalmology, National University Health System, Singapore.
authors.forename: Gangadhara
authors.initials: G
authors.lastname: Sundar
authors.affiliation: Orbit & Oculofacial Surgery, Department of Ophthalmology, National University Health System, Singapore.
authors.forename: Shantha
authors.initials: S
authors.lastname: Amrith
authors.affiliation: Division of Endocrinology, Department of Medicine, National University of Singapore.
authors.forename: Kok Onn
authors.initials: KO
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003316:Corneal Diseases / Q000175:diagnosis / Q000453:epidemiology; D005006:Ethnicity; D005094:Exophthalmos / Q000175:diagnosis / Q000453:epidemiology; D005141:Eyelid Diseases / Q000151:congenital / Q000175:diagnosis / Q000453:epidemiology; D005143:Eyelids / Q000002:abnormalities; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D049970:Graves Ophthalmopathy / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D009901:Optic Nerve Diseases / Q000175:diagnosis / Q000453:epidemiology; D012189:Retrospective Studies; D012846:Singapore / Q000453:epidemiology
chemical_list: D005938:Glucocorticoids
keywords: Orbit