Avaliação da superfície ocular em pacientes com doença ocular da tireoide

Detalhes bibliográficos
Ano de defesa: 2025
Autor(a) principal: Rôxo, Alana Almeida lattes
Orientador(a): Ramos, Helton Estrela lattes
Banca de defesa: Ramos, Helton Estrela lattes, Castelo Branco, Bruno lattes, Cury, Adriano Namo lattes
Tipo de documento: Dissertação
Tipo de acesso: Acesso aberto
Idioma: por
Instituição de defesa: Universidade Federal da Bahia
Programa de Pós-Graduação: Programa de Pós-Graduação em Processos Interativos dos Órgãos e Sistemas (PPGORGSISTEM) 
Departamento: Instituto de Ciências da Saúde - ICS
País: Brasil
Palavras-chave em Português:
Oftalmopatia associada à tireoide
Oftalmopatia de Graves
Doença Ocular da Tireoide (DOT)
Doença do olho seco
Síndromes do Olho Seco
Doença da superfície ocular
Área do conhecimento CNPq:
CNPQ::CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA::OFTALMOLOGIA
CNPQ::CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA
CNPQ::CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA::ENDOCRINOLOGIA
Link de acesso: https://repositorio.ufba.br/handle/ri/43031
Resumo: Introdução – 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.
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spelling 2025-09-25T15:42:46Z2025-09-25T15:42:46Z2025-05-26RÔXO, 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.https://repositorio.ufba.br/handle/ri/43031Introdução – 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.Introduction: 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.porUniversidade Federal da BahiaPrograma de Pós-Graduação em Processos Interativos dos Órgãos e Sistemas (PPGORGSISTEM) UFBABrasilInstituto de Ciências da Saúde - ICSThyroid-associated ophthalmopathyGraves OphthalmopathyThyroid eye diseaseDry Eye SyndromesOcular surface diseaseCNPQ::CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA::OFTALMOLOGIACNPQ::CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICACNPQ::CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA::ENDOCRINOLOGIAOftalmopatia associada à tireoideOftalmopatia de GravesDoença Ocular da Tireoide (DOT)Doença do olho secoSíndromes do Olho SecoDoença da superfície ocularAvaliação da superfície ocular em pacientes com doença ocular da tireoideEvaluation of the ocular surface in patients with thyroid eye diseaseMestrado Acadêmicoinfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/publishedVersionRamos, Helton Estrelahttps://orcid.org/0000-0002-2900-2099http://lattes.cnpq.br/5624505454133902Sardinha, Mariluze Maria de Souzahttp://lattes.cnpq.br/0990732888878696Ramos, Helton Estrelahttps://orcid.org/0000-0002-2900-2099http://lattes.cnpq.br/5624505454133902Castelo Branco, Brunohttps://orcid.org/0009-0001-3667-167Xhttp://lattes.cnpq.br/8913177316699431Cury, Adriano Namohttps://orcid.org/0000-0002-9777-8366http://lattes.cnpq.br/7133785713614688https://orcid.org/0009-0006-1944-9205https://lattes.cnpq.br/0827275738994399Rôxo, Alana Almeida1. 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dc.title.pt_BR.fl_str_mv Avaliação da superfície ocular em pacientes com doença ocular da tireoide
dc.title.alternative.pt_BR.fl_str_mv Evaluation of the ocular surface in patients with thyroid eye disease
title Avaliação da superfície ocular em pacientes com doença ocular da tireoide
spellingShingle Avaliação da superfície ocular em pacientes com doença ocular da tireoide
Rôxo, Alana Almeida
CNPQ::CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA::OFTALMOLOGIA
CNPQ::CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA
CNPQ::CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA::ENDOCRINOLOGIA
Oftalmopatia associada à tireoide
Oftalmopatia de Graves
Doença Ocular da Tireoide (DOT)
Doença do olho seco
Síndromes do Olho Seco
Doença da superfície ocular
Thyroid-associated ophthalmopathy
Graves Ophthalmopathy
Thyroid eye disease
Dry Eye Syndromes
Ocular surface disease
title_short Avaliação da superfície ocular em pacientes com doença ocular da tireoide
title_full Avaliação da superfície ocular em pacientes com doença ocular da tireoide
title_fullStr Avaliação da superfície ocular em pacientes com doença ocular da tireoide
title_full_unstemmed Avaliação da superfície ocular em pacientes com doença ocular da tireoide
title_sort Avaliação da superfície ocular em pacientes com doença ocular da tireoide
author Rôxo, Alana Almeida
author_facet Rôxo, Alana Almeida
author_role author
dc.contributor.advisor1.fl_str_mv Ramos, Helton Estrela
dc.contributor.advisor1ID.fl_str_mv https://orcid.org/0000-0002-2900-2099
dc.contributor.advisor1Lattes.fl_str_mv http://lattes.cnpq.br/5624505454133902
dc.contributor.advisor-co1.fl_str_mv Sardinha, Mariluze Maria de Souza
dc.contributor.advisor-co1Lattes.fl_str_mv http://lattes.cnpq.br/0990732888878696
dc.contributor.referee1.fl_str_mv Ramos, Helton Estrela
dc.contributor.referee1ID.fl_str_mv https://orcid.org/0000-0002-2900-2099
dc.contributor.referee1Lattes.fl_str_mv http://lattes.cnpq.br/5624505454133902
dc.contributor.referee2.fl_str_mv Castelo Branco, Bruno
dc.contributor.referee2ID.fl_str_mv https://orcid.org/0009-0001-3667-167X
dc.contributor.referee2Lattes.fl_str_mv http://lattes.cnpq.br/8913177316699431
dc.contributor.referee3.fl_str_mv Cury, Adriano Namo
dc.contributor.referee3ID.fl_str_mv https://orcid.org/0000-0002-9777-8366
dc.contributor.referee3Lattes.fl_str_mv http://lattes.cnpq.br/7133785713614688
dc.contributor.authorID.fl_str_mv https://orcid.org/0009-0006-1944-9205
dc.contributor.authorLattes.fl_str_mv https://lattes.cnpq.br/0827275738994399
dc.contributor.author.fl_str_mv Rôxo, Alana Almeida
contributor_str_mv Ramos, Helton Estrela
Sardinha, Mariluze Maria de Souza
Ramos, Helton Estrela
Castelo Branco, Bruno
Cury, Adriano Namo
dc.subject.cnpq.fl_str_mv CNPQ::CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA::OFTALMOLOGIA
CNPQ::CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA
CNPQ::CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA::ENDOCRINOLOGIA
topic CNPQ::CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA::OFTALMOLOGIA
CNPQ::CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA
CNPQ::CIENCIAS DA SAUDE::MEDICINA::CLINICA MEDICA::ENDOCRINOLOGIA
Oftalmopatia associada à tireoide
Oftalmopatia de Graves
Doença Ocular da Tireoide (DOT)
Doença do olho seco
Síndromes do Olho Seco
Doença da superfície ocular
Thyroid-associated ophthalmopathy
Graves Ophthalmopathy
Thyroid eye disease
Dry Eye Syndromes
Ocular surface disease
dc.subject.por.fl_str_mv Oftalmopatia associada à tireoide
Oftalmopatia de Graves
Doença Ocular da Tireoide (DOT)
Doença do olho seco
Síndromes do Olho Seco
Doença da superfície ocular
dc.subject.other.pt_BR.fl_str_mv Thyroid-associated ophthalmopathy
Graves Ophthalmopathy
Thyroid eye disease
Dry Eye Syndromes
Ocular surface disease
description Introdução – 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.
publishDate 2025
dc.date.accessioned.fl_str_mv 2025-09-25T15:42:46Z
dc.date.available.fl_str_mv 2025-09-25T15:42:46Z
dc.date.issued.fl_str_mv 2025-05-26
dc.type.driver.fl_str_mv Mestrado Acadêmico
info:eu-repo/semantics/masterThesis
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
format masterThesis
status_str publishedVersion
dc.identifier.citation.fl_str_mv RÔXO, 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.
dc.identifier.uri.fl_str_mv https://repositorio.ufba.br/handle/ri/43031
identifier_str_mv RÔXO, 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.
url https://repositorio.ufba.br/handle/ri/43031
dc.language.iso.fl_str_mv por
language por
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