Steroid pulse and orbital radiation therapies do not alter signs associated with dry eye and meibomian gland dysfunction (MGD) status for patients with thyroid eye disease (TED), according to research published in the Journal of Clinical Medicine.
Researchers enrolled 16 patients (13 women; mean age, 60.2±10.5 years) with active TED in the study. Patients underwent tear breakup time (TBUT), Schirmer 1, and tear meniscus height (TMH) analysis and reported dry eye-related quality of life scores (DEQS). The cohort underwent MGD score, meibomian expression, and meibomian gland loss assessment to evaluate MGD. All participants received steroid and orbital radiation therapies. Assessments were performed prior to treatment and at a 6-month follow-up visit.
Investigators report significant clinical activity score (CAS) improvement following treatment (P =.001). Margin reflex distance (MRD-1) also decreased at follow-up (P =.046). Marx line score (P =.060), meibum expression score (P =.034), and meibomian gland loss scores in the upper eyelid (P =.025) improved following treatment. Treatment did not significantly affect any other measured items.
Researchers explain that steroid pulse and orbital radiation therapies not only fail to relieve dry eye symptomatology, the latter therapy may actually cause it.
“Orbital radiation therapy itself can cause new-onset dry eye or deteriorates dry eye status,” according to the report. “Proposed mechanisms of this complication are depletion of goblet cells and damage on the lacrimal and meibomian glands.”
Study limitations include a small sample size, a high loss to follow-up, confounding due to variations in smoking habits among the cohort, and a short study duration.
Takahashi Y, Vaidya A, Kakizaki H. Changes in dry eye status after steroid pulse and orbital radiation therapies in active thyroid eye disease. J Clin Med. Published online June 22, 2022. doi:10.3390/jcm11133604