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Meibomian gland dysfunction in Graves’ orbitopathy

      Abstract

      Objective

      To examine morphologic changes in the meibomian glands associated with patients with Graves’ orbitopathy (GO) using a novel meibography imaging system, and to evaluate its correlation with GO clinical manifestations.

      Design

      Retrospective, observational case series.

      Participants

      Fifty-one GO patients and 31 normal control participants.

      Methods

      This retrospective study examined 51 GO patients and 31 normal control participants. The structure of the meibomian gland was assessed using the meibography imaging system. All of the participants completed the Ocular Surface Disease Index (OSDI) questionnaire. The tear film break-up time (BUT) was measured. The palpebral fissure height, exophthalmos, and eyelid retraction were also assessed.

      Results

      The meibography score, tear film BUT, and OSDI indicated statistically significant differences between the GO and normal groups: The tear film BUT was shorter and the OSDI and meibography score were higher in the GO patient group. There was a significant negative correlation between the meibography score and the tear film BUT in GO patients (r = –.503 and p < .001). In the multivariable linear regression analysis, the meibography score of the GO patients had a positive association with exophthalmos and palpebral fissure height.

      Conclusions

      Compared with the normal control participants, GO patients had more unstable tear films and severe symptoms of dry eye. Using the meibography system, the authors found that GO patients had a higher prevalence of obstructive type meibomian gland dysfunction and changes in meibomian glands increased, with proptosis and lid fissure widening.

      Résumé

      Objet?>

      Examiner les changements morphologiques des glandes de Meibomius chez les patients atteints d’orbitopathie de Graves (OG) à l’aide d’un nouveau système d’imagerie, et évaluer les corrélations entre cette méthode et les manifestations cliniques d’OG.

      Nature?>

      Observation rétrospective d’une série de cas.

      Participants?>

      51 patients atteints d’OG et un groupe témoin composé de 31 sujets normaux.

      Méthodes?>

      Cette étude rétrospective porte sur l’examen de 51 patients atteints d’OG et de 31 sujets normaux. Nous avons évalué la structure de la glande de Meibomius à l’aide d’un nouveau système d’imagerie (meibography imaging system). Tous les sujets ont répondu au questionnaire Ocular Surface Disease Index (indice de maladie de la surface oculaire ou IMSO) et ont subi un test du temps de rupture du film lacrymal (TRFL). La hauteur de la fissure palpébrale, l’exophtalmie et la rétraction de la paupière ont aussi été évaluées.

      Résultats?>

      Les résultats de l’imagerie, du TRFL et de l’IMSO ont montré des différences statistiquement significatives entre le groupe des patients atteints d’OG et le groupe témoin : le temps de rupture était inférieur, et l’IMSO et le résultat de l’imagerie étaient supérieurs chez les patients atteints d’OG. Nous avons aussi constaté une corrélation négative significative entre le résultat de l’imagerie et le TRFL chez les patients atteints d’OG (r = −0,503 et p < 0,001). La régression linéaire multivariables a démontré une corrélation positive entre le résultat de l’imagerie des patients atteints d’OG, et l’exophtalmie et la hauteur de la fissure palpébrale.

      Conclusions?>

      Comparativement aux sujets témoins normaux, les patients atteints d’OG avaient un temps de rupture du film lacrymal plus instable et des symptômes graves de sécheresse oculaire. Le nouveau système d’imagerie a permis aux auteurs de découvrir une prévalence supérieure de la dysfonction des glandes de Meibomius de type obstructive chez les patients atteints d’OG, et que l’exophtalmie et l’élargissement de la fissure palpébrale touchaient encore plus les glandes de Meibomius.
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