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dc.creatorRôxo, Alana Almeida-
dc.date.accessioned2025-09-25T15:42:46Z-
dc.date.available2025-09-25T15:42:46Z-
dc.date.issued2025-05-26-
dc.identifier.citationRÔXO, Alana Almeida. Avaliação da superfície ocular em pacientes com doença ocular da tireoide. Orientador: Helton Estrela Ramos; Coorientadora: Mariluze Maria de Souza Sardinha. 2025. 93 f. Dissertação (Mestrado em Processos Interativos dos Órgãos e Sistemas) - Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador (BA), 2025.pt_BR
dc.identifier.urihttps://repositorio.ufba.br/handle/ri/43031-
dc.description.abstractIntroduction: Thyroid eye disease (TED) is the most common and severe extrathyroidal manifestation in patients with Graves' disease, affecting 25-50% of these patients. Ocular surface disease (OSD) is a multifactorial disorder characterised by an imbalance in tear film homeostasis, resulting from deficient tear production and/or excessive tear evaporation. In TED, the enlargement of the palpebral fissure, combined with eyelid changes and proptosis, results in increased corneal exposure, tear film instability, accelerated tear evaporation, and increased tear osmolarity. OSD in the context of TED is traditionally considered a natural consequence of these anatomical changes. However, a growing body of research suggests that ocular surface inflammation and multifactorial alterations in ocular surface homeostasis contribute substantially to the OSD observed in patients with TED. Objective: to analyse the association between ocular surface disease (OSD) and thyroid eye disease (TED) in the active and inactive phases in patients followed at two SUS care services: (i) Ophthalmology Services, Professor Francisco Magalhães Neto Outpatient Clinic (AMN), HUPES complex, UFBA; and (ii) Ophthalmology Outpatient Clinic, Santo Antônio Hospital, Irmã Dulce Social Works (OSID). Material and Methods: this is a multicenter, cross-sectional, observational, and analytical cohort study. The study population consisted of 51 patients, corresponding to 102 eyes, of TED patients followed at the Ocular Plastic Surgery outpatient clinics of the Ophthalmology services of AMN/HUPES and OSID. Results: the mean age was 47.92 (±13.21) years. The female-to-male ratio in our study was 2.92:1. Considering the inflammatory activity of TED, 42/51 (82.4%) eyes were in the inactive phase (CAS < 3) and 9/51 (17.6%) were in the active phase of the disease (CAS ≥ 3), considering for the calculation, the eye with the highest CAS value, in asymmetric orbital disease. The majority (88.2%) of the eyes presented normal values in the Schirmer test with an anaesthetic. Only 6/51 (11.8%) eyes presented normal results in the BUT. Regarding staining with fluorescein and lissamine green, 21/51 (41.2%) and 7/51 (13.7%), respectively, of the eyes had positive results for DSO. The mean OSDI score was higher in the inflammatory DOT group (18.64 ± 13.08), compared to patients with inactive DOT (14.88 ± 10.89). Three-nine (33.3%) eyes presented features of MGD on biomicroscopy. Conclusion: We conclude that OSD is quite prevalent in patients with TED. However, interpreting the results of all current diagnostic tests for OSD remains difficult due to their frequent discordance and low correlation, especially in the OSD patients evaluated. In our sample, the strongest correlations were observed between lissamine green/Schirmer and fluorescein staining/OSDI. Future studies to establish a test with universally accepted cutoffs or a gold standard for OSD are increasingly necessary and highlight the unmet need of a large population suffering from OSD-related changes.pt_BR
dc.languageporpt_BR
dc.publisherUniversidade Federal da Bahiapt_BR
dc.rightsAcesso Abertopt_BR
dc.subjectOftalmopatia associada à tireoidept_BR
dc.subjectOftalmopatia de Gravespt_BR
dc.subjectDoença Ocular da Tireoide (DOT)pt_BR
dc.subjectDoença do olho secopt_BR
dc.subjectSíndromes do Olho Secopt_BR
dc.subjectDoença da superfície ocularpt_BR
dc.subject.otherThyroid-associated ophthalmopathypt_BR
dc.subject.otherGraves Ophthalmopathypt_BR
dc.subject.otherThyroid eye diseasept_BR
dc.subject.otherDry Eye Syndromespt_BR
dc.subject.otherOcular surface diseasept_BR
dc.titleAvaliação da superfície ocular em pacientes com doença ocular da tireoidept_BR
dc.title.alternativeEvaluation of the ocular surface in patients with thyroid eye diseasept_BR
dc.typeDissertaçãopt_BR
dc.publisher.programPrograma de Pós-Graduação em Processos Interativos dos Órgãos e Sistemas (PPGORGSISTEM) pt_BR
dc.publisher.initialsUFBApt_BR
dc.publisher.countryBrasilpt_BR
dc.subject.cnpqCNPQ::CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA::OFTALMOLOGIApt_BR
dc.subject.cnpqCNPQ::CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICApt_BR
dc.subject.cnpqCNPQ::CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA::ENDOCRINOLOGIApt_BR
dc.contributor.advisor1Ramos, Helton Estrela-
dc.contributor.advisor1IDhttps://orcid.org/0000-0002-2900-2099pt_BR
dc.contributor.advisor1Latteshttp://lattes.cnpq.br/5624505454133902pt_BR
dc.contributor.advisor-co1Sardinha, Mariluze Maria de Souza-
dc.contributor.advisor-co1Latteshttp://lattes.cnpq.br/0990732888878696pt_BR
dc.contributor.referee1Ramos, Helton Estrela-
dc.contributor.referee1IDhttps://orcid.org/0000-0002-2900-2099pt_BR
dc.contributor.referee1Latteshttp://lattes.cnpq.br/5624505454133902pt_BR
dc.contributor.referee2Castelo Branco, Bruno-
dc.contributor.referee2IDhttps://orcid.org/0009-0001-3667-167Xpt_BR
dc.contributor.referee2Latteshttp://lattes.cnpq.br/8913177316699431pt_BR
dc.contributor.referee3Cury, Adriano Namo-
dc.contributor.referee3IDhttps://orcid.org/0000-0002-9777-8366pt_BR
dc.contributor.referee3Latteshttp://lattes.cnpq.br/7133785713614688pt_BR
dc.creator.IDhttps://orcid.org/0009-0006-1944-9205pt_BR
dc.creator.Latteshttps://lattes.cnpq.br/0827275738994399pt_BR
dc.description.resumoIntrodução – A doença ocular da tireoide (DOT) é a manifestação extratireoidiana mais comum e grave, em pacientes portadores da doença de Graves, acometendo 25 a 50% desses pacientes. A doença da superfície ocular (DSO) é um distúrbio multifatorial, caracterizado por um desequilíbrio na homeostase do filme lacrimal decorrente de deficiência na produção e (ou) evaporação excessiva da lágrima. Na DOT, o aumento da fissura palpebral, somado a alterações da pálpebra e proptose, resulta em maior exposição da córnea, instabilidade do filme lacrimal, evaporação acelerada da lágrima e aumento de sua osmolaridade. A DSO, no contexto da DOT, é tradicionalmente considerada uma consequência natural dessas alterações anatômicas. No entanto, um crescente número de pesquisas sugere que a inflamação da superfície ocular e as alterações multifatoriais na homeostase da superfície ocular contribuem substancialmente para a DSO observada em pacientes com DOT. Objetivo – Analisar a associação entre doença da superfície ocular (DSO) e doença ocular da tireoide (DOT), nas fases ativa e inativa, em pacientes acompanhados em dois serviços de atendimento ao SUS: serviços de oftalmologia do ambulatório Professor Francisco Magalhães Neto (AMN), do complexo HUPES, da UFBA, e Ambulatório de Oftalmologia do Hospital Santo Antônio, das obras Sociais Irmã Dulce (OSID). Material e métodos – Trata-se de um estudo de coorte, multicêntrico, transversal, observacional e analítico. A população do estudo foi constituída por 51 pacientes, correspondendo a 102 olhos de portadores de DOT, acompanhados nos ambulatórios de plástica ocular dos serviços de oftalmologia do AMN/HUPES e da OSID. Resultados – A média da idade foi 47,92 (±13,21) anos. A proporção de mulheres para homens, em nosso estudo, foi de 2,92:1. Considerando-se a atividade inflamatória da DOT, 42/51 (82,4%) olhos encontravam-se na fase inativa (CAS < 3) e 9/51 (17,6%) estavam na fase ativa da doença (CAS ≥ 3), considerando-se, para o cálculo, o olho com maior valor do CAS, na doença orbitária assimétrica. A maioria (88,2%) dos olhos apresentou os valores normais do teste de Schirmer com anestésico. Apenas 6/51 (11,8%) olhos apresentaram resultados normais ao BUT. Em relação à coloração com fluoresceína e lissamina verde, 21/51 (41,2%) e 7/51 (13,7%) olhos, respectivamente, tiveram resultados positivos para DSO. A pontuação média do OSDI foi maior no grupo de DOT inflamatória (18,64 ± 13,08), em relação aos pacientes com DOT inativa (14,88 ± 10,89). 3/9 (33,3%) olhos apresentaram características de DGM ao exame de biomicroscopia. Conclusão – Concluímos que a DSO é bastante prevalente em pacientes com DOT. Entretanto, continua a ser bastante difícil interpretar os resultados do conjunto dos atuais testes diagnósticos para a DSO, devido a sua frequente discordância e baixa correlação, sobretudo nos pacientes com DOT avaliados. Em nossa amostra, as correlações mais fortes foram observadas entre a lissamina verde/Schirmer e coloração com fluoresceína/OSDI. No futuro, novos estudos são necessários para estabelecer um teste com pontos de corte universalmente aceitos ou um teste padrão-ouro para DSO. Destaca-se a necessidade não atendida de uma grande população que sofre com as alterações relacionadas à DSO.pt_BR
dc.publisher.departmentInstituto de Ciências da Saúde - ICSpt_BR
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