TOBACCO SMOKING IN HYPERTHYROID EYE DISEASE

Abstract

GD is a common autoimmune endocrinal disease, which characterized by thyroid hyperplasia and increased thyroid hormone. TED is the most common extra thyroidal manifestation of GD. TED is an extremely unpleasant, painful, cosmetically distressing and occasionally sight threating disease. TED is thought to be related to T-cells reacting against thyroid follicular cells, which share antigenic epitopes in the orbit. Histology of extraocular muscles shows edema, pleomorphic cellular infiltration, and necrosis. Also, orbital fat, connective tissue, and lacrimal glands become infiltrated with inflammatory cells, GAG deposition, and edema. The muscles or orbital fat swell, causing proptosis and potentially compress the optic nerve. Later in the disease the muscle fibres fibrose, leading to restriction of extraocular muscles. The most important preventable causes of visual loss in this condition are corneal exposure and optic nerve compression. Symptoms of TED depend on the degree of activity and severity of the disease. The ocular manifestations include pain, conjuctival chemosis, eyelid retraction corneal exposure, diplopia, exophthalmos and optic nerve compression. Aim of the work was to assess the incidence of tobacco smoking among patients with TED. Our cross-sectional study included 50 patients, 40/50 patients (80%) were TED patients (group I), 33(82.5%) of them were active smokers (group Ia), 10/50 patients (20 %) had no TED (group II), 8(80%) of them were active smokers (Group IIa). In the current study, females are much more commonly affected than males with ratio 4:1. Symptoms of TED were more common among patients in group Ia than other groups, in group Ia, 11 (33.3%) patients were complaining orbital pain, (33.3%) patients were complaining of gaze evoked pain, 17 (51.5%) patients were complaining of watering, 3(9.1%) were complaining from blurred vision and All patients (100%) had no diplopia while in group Ib only, 3 (42.9%) patients were complaining from watering. In the current study, most of patients presented with good visual acuity; the mean BCVA was 0.92 ± 0.11 SD (range: 0.63–1), On comparisonbetween group Ia and group Ib regarding the clinical signs, there was highly statistically significant difference regarding proptosis and lid retraction and there was a statistically significant difference regarding the mean intraocular pressure and presence of lid erythema. There was no statistically significant difference between both groups regarding the other signs. In the present study, the clinical activity score was higher in group Ia than in other groups; There was a statistically significant difference between group Ia and group IIa regarding mean number of total CAS score (P-value = 0.027) and Pearson’s Correlation shows a significant correlation between the items of smoking questionnaire and the total CAS, Modified NOSPECS score and the mean reading of Hertel’s exophthalmometer of both eyes.