Thyroid eye disease: a Southeast Asian experience

Br J Ophthalmol. 2015 Apr;99(4):512-8. doi: 10.1136/bjophthalmol-2014-305649. Epub 2014 Oct 31.

Abstract

Aim: 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.

Keywords: Orbit.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Comorbidity
  • Corneal Diseases / diagnosis
  • Corneal Diseases / epidemiology
  • Ethnicity
  • Exophthalmos / diagnosis
  • Exophthalmos / epidemiology
  • Eyelid Diseases / congenital
  • Eyelid Diseases / diagnosis
  • Eyelid Diseases / epidemiology
  • Eyelids / abnormalities
  • Female
  • Glucocorticoids / therapeutic use
  • Graves Ophthalmopathy / diagnosis
  • Graves Ophthalmopathy / epidemiology*
  • Graves Ophthalmopathy / therapy
  • Humans
  • Infant
  • Male
  • Middle Aged
  • Ophthalmologic Surgical Procedures
  • Optic Nerve Diseases / diagnosis
  • Optic Nerve Diseases / epidemiology
  • Retrospective Studies
  • Singapore / epidemiology

Substances

  • Glucocorticoids

Supplementary concepts

  • Epiblepharon of Upper Lid