Objective To investigate the correlation between orbit inflammation and ocular surface characteristic in patients with thyroid associated ophthalmopathy (TAO).Methods Prospective observational cohort study.A total of 56 patients with TAO and 20 normal participants were recruited.TAO patients were divided into active TAO and inactive TAO based on the seven-point modified formulation of Clinical Activity Score (CAS).All participants underwent a full eye examination including the assessment of Ocular Surface Disease Index (OSDI) score,tear film break-up time (TBUT),Fluorescein staining,Schirmer test.39 TAO patients were assessed for the Nelson's grade of conjunctiva impression cytology,and measured the proptosis,palpebral fissure width and lagophthalmos.The one-way ANOVA with the LSD post hoc test was used for comparisons among active TAO,inactive TAO and controls.χ2 test was used to analyze the binary data.Results There were no significant differences in the ocular surface parameters including proptosis,palpebral fissure width and lagophthalmos between active TAO and inactive TAO (P>0.05).Fluorescein staining scores were higher,BUT scores were shorter,and the Schirmer test scores were significantly lower in both active and inactive TAO than the control (P<0.001),while TBUT scores were significantly lower in active TAO compared with the inactive TAO(P<0.01).OSDI scores were significantly higher in active TAO compared with the inactive TAO (P<0.001).Impression cytology revealed more proportion of grade 2~3 change in active TAO compared with the inactive TAO(P<0.001).Conclusion Orbit inflammation in TAO patients may lead to decreased tear film stability and ocular surface squamous metaplasia.%目的 研究甲状腺相关眼病(TAO)患者眼眶炎症水平与眼表功能间相互关系.方法 采用横断面病例观察研究.根据改良临床活动性评分将56例TAO患者分为活动期TAO组19例与静止期TAO组37例,并选取无眼表症状正常人20例作为对照组.采用OSDI问卷定量评估眼表症状,测量眼表解剖参数(眼球突出度、睑裂高度、眼睑闭合不全程度)、泪膜破裂时间(TBUT)、角膜荧光素染色(Fl)评分、基础泪液分泌试验(St).对其中39例TAO患者行结膜印迹细胞学(IC)光镜检查并分级.3组间比较采用单因素方差分析及LSD-t检验,IC检查结果比较采用χ2检验.结果 活动期TAO组与静止期TAO组眼球突出度、睑裂高度、眼睑闭合不全程度比较,差别无统计学意义(P>0.05).活动期TAO组与静止期TAO组TBUT均较对照组缩短(P<0.001),Fl评分增高(P<0.001),St减少(P<0.001).活动期TAO组较静止期TAO组OSDI评分增高(P<0.01),TBUT缩短(P<0.001).IC检查Nelson分级发现,活动期TAO组2~3级比例较静止期TAO组增高(P<0.001).结论 TAO患者眼眶炎症可导致泪膜稳定性下降,眼表上皮鳞状化生.
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