Subjective versus Objective Dry Eye Disease in Patients with Moderate-Severe Thyroid Eye Disease

Purpose: To compare the subjective versus Objective dry eye disease (DED) in patients with moderate-severe thyroid eye disease (TED). Methods: Patients (≥18 years) filled ocular surface disease index (OSDI) questionnaire and had Schirmer, Tear breakup time (TBUT), fluorescein staining, osmolarity, corneal aesthesiometry, meibomian gland dysfunction (MGD) tests. Excluded were patients with a history of disease, surgery, and medications affecting the ocular surface and incomplete tests results. Subjective DED was defined as the OSDI score of ≥13, objective as one positive test, and definite as the sum of both. Results: Included were 38 patients (74 eyes) with the mean age of 40 years. Subjective DED was observed in 77%, objective in 89.2 %, and definite in 67.7% of the eyes. Severe subjective DED was found in 36.5% and objective in 24.3%. TBUT was the most frequent positive test (63.5%). MGD was observed in 56.8% of the eyes. Mean clinical activity score, palpebral fissure, rundle grading, proptosis, corneal aesthesiometry, and presence of MGD were not significantly different between the eyes with and without DED. Conclusion: Definite DED was found in more than 2/3 of the eyes. While objective DED was more prevalent than subjective, the severe form of subjective DED was more frequent. No variable was significantly different betweenthe eyes with and without subjective, objective and definite DED.