Discussion
corneal injury, inflammation, different disease, limbal keratoconjunctivitis, TAO, dry eye syndrome, corneal epithelial injury
EYE INFLAMMATION, EXOPHTHALMOS, INFLAMMATION, DISEASE, DRY EYE SYNDROME, DRY EYE, EYE MOVEMENT DISORDERS, DRY EYE SYNDROME, TAO
Dry eye syndrome is an important factor that causes eye discomfort in TAO patients clinically, which is closely related to the increase of tear evaporation and osmotic pressure caused by the increase of ocular surface exposure, the change of tear composition caused by eye inflammation, and eye movement disorders. However, the treatment for TAO with dry eye syndrome has not been standardized, and there are few articles on related issues. Therefore, this article aimed to provide high-quality clinical evidence for the treatment of TAO patients with dry eye syndrome.The first problem was the selection of research objects. The ocular manifestations of patients with extremely severe TAO or with active TAO are still changing, so it is difficult to distinguish whether the effect of drug treatment is affected by the development of the disease. Therefore, we choose patients with mild or moderate-to-severe TAO patients as subjects and the disease stages of all subjects were inactive. At baseline, we evaluated the patients’ age and gender. In our study, the average age of the subjects was slightly lower than the results of some previous study [ST and BUT are objective indexes to evaluate the dry eye, which reflect the stability of tear film and basic tear secretion. These two indicators have decreased in varying degrees in TAO patients with dry eye syndrome because of the increase of exposure factors, the occurrence of inflammation and the reduction of tear secretion. The ST of Group A increased from 8.61 ± 6.34 mm to 9.13 ± 7.1 mm (FL examination can be used to assess the degree of corneal epithelial injury. Due to the increase of ocular surface exposure and exophthalmos, the FL grade of TAO patients with dry eye syndrome would increase as the baseline data showed. A past study showed that the topical use of Rebamipide for 1 month improves the upper limbal keratoconjunctivitis of TAO patients and repairs the corneal injury [The OSDI scale evaluates the subjective feeling of the patients [Overall, the efficiency of vitamin A palmitate eye gel on TAO with dry eye syndrome was significantly higher than that of sodium hyaluronate eye drop. Both improved corneal epithelial injury and index for evaluating the dry eye. Therefore, these two drugs could be utilized clinically to improve the dry eye syndrome of TAO patients. Nevertheless, the present study has some deficiencies. It is a single-center study with a small sample size and short observation time. TAO patients with different disease stages or grading may have varied responses to the topical eye drops. In addition, 15 subjects in this study missed their follow-up due to the COVID-19 pandemic. However, this study still has high credibility because the initial sample size included a lost visit rate of only 20%. Further studies should be focused on other drugs such as sodium hyaluronate eye drops with higher concentration and the superimposed use of drugs to explore the local treatment scheme of TAO with dry eye syndrome. In the past studies, the description of the role of cyclosporine in TAO patients with dry eye syndrome had the opposite conclusion [