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Clinicopathological Evaluation of Dry eyes and Ocular surface in Newly diagnosed patients of Hyperthyroidism and Hypothyroidism and its Comparison With Healthy Subjects

Purpose: To evaluate tear function test, corneal surface disorder in recently diagnosed hyperthyroid and hypothyroid patients & to compare results with healthy subjects. Setting/Venue: Mahatma Gandhi Medical College, Jaipur, Rajasthan, India Methods: Cross sectional analytical study. 30 recently diagnosed (within 3 months of diagnosis) patients of hyperthyroidism and hypothyroidism each and 30 healthy age matched controls were included. All patients and controls underwent assessment of proptosis, Palpebral fissure-height (PFH), tear function test (OSDI questionnaire, Schirmers test and Tear Break-up-time (TBUT) and Impression Cytology for ocular surface assessment. These parameters were compared between cases and controls. Standard statistical analysis was used. Results: Mean Proptosis and PFH showed no significant difference among groups (P value =.071). Mean value of OSDI was 42.33+22.67, 41.15+16.03 and 29.33+6.84 in hyperthyroid, hypothyroid and Controls respectively, the difference being statistically significant (p=.001). Mean TBUT was 7.13+3.28 sec, 6.38+2.46 sec, and 11.15+2.39 sec in hyperthyroidism, hypothyroidism and controls respectively (p=0.001). Mean value of Schirmer tear test was 12.93+5.81mm, 13.30+4.44mm, and 17.55+7.35mm in hyperthyroidism, Hypothyroidism and controls respectively (p=0.001). 80% of patients in hyperthyroidism group had grade 2-3 squamous metaplasia as compared to 70% in hypothyroidism patients and 24.4% in controls, signifying ocular surface damage (pvalue < 0.05). Conclusion: Mean PFH and proptosis did not differ between three groups. However, increased OSDI score, decreased Schirmer test value, decreased TBUT and grade 2-3 squamous metaplasia in patients of thyroid dysfunction suggests presence of dry eyes. Despite no clinically visible signs of thyroid ophthalmopathy, there is ocular surface damage right from the early stages of thyroid dysfunction. This is attributable to evaporative mechanism as well as ocular surface inflammation & hyperosmolarity of tear film.