{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T20:42:57Z","timestamp":1789850577004,"version":"4.0.1"},"reference-count":31,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2021,8,20]],"date-time":"2021-08-20T00:00:00Z","timestamp":1629417600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"The Ministry of Education, Culture, Sports, Science, and Technology in Japan","award":["15K20292"],"award-info":[{"award-number":["15K20292"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The aim of this prospective observational study was to examine changes in eyelid pressure and dry eye status after orbital decompression in thyroid eye disease (TED). In 16 patients (29 sides), upper eyelid pressure at plateau phase and maximum pressure were measured. TED status was evaluated through the Hertel exophthalmometric value and margin reflex distance (MRD)-1 and 2. Dry eye status was quantified through corneal fluorescein staining, tear break-up time, Schirmer test I results, meibomian gland dysfunction (MGD), tear meniscus height, and superior limbic keratoconjunctivitis (SLK). Patients were classified into two groups: patients with decreased eyelid pressure (Group 1) and those with elevated pressure (Group 2). Consequently, neither the maximum upper eyelid pressure nor pressure at plateau phase significantly changed after surgery (p &gt; 0.050). Some parameters about MGD improved after surgery, but the other parameters on dry eye, MGD, and SLK worsened or did not change. MRD-1 decreased more (p = 0.028), and the ratio of patients in whom SLK improved after surgery was larger in Group 1 (p = 0.030). These results indicate that upper eyelid pressure tends to decrease postoperatively in patients with a high upper eyelid position, resulting in improvement of SLK.<\/jats:p>","DOI":"10.3390\/jcm10163687","type":"journal-article","created":{"date-parts":[[2021,8,20]],"date-time":"2021-08-20T08:44:45Z","timestamp":1629449085000},"page":"3687","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Changes in Eyelid Pressure and Dry Eye Status after Orbital Decompression in Thyroid Eye Disease"],"prefix":"10.3390","volume":"10","author":[{"given":"Yasuhiro","family":"Takahashi","sequence":"first","affiliation":[{"name":"Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Aichi 480-1195, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aric","family":"Vaidya","sequence":"additional","affiliation":[{"name":"Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Aichi 480-1195, Japan"},{"name":"Department of Oculoplastic, Orbital & Lacrimal Surgery, Rapti Eye Hospital, Dang 22412, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirohiko","family":"Kakizaki","sequence":"additional","affiliation":[{"name":"Department of Oculoplastic, Orbital & Lacrimal Surgery, Aichi Medical University Hospital, Aichi 480-1195, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,8,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1097\/ICL.0b013e318268610a","article-title":"Blepharo-tensiometer: New eyelid pressure measurement system using tactile pressure sensor","volume":"38","author":"Sakai","year":"2012","journal-title":"Eye Contact Lens"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1016\/j.ajo.2013.12.027","article-title":"Topical rebamipide treatment for superior limbic keratoconjunctivitis in patients with thyroid eye disease","volume":"157","author":"Takahashi","year":"2014","journal-title":"Am. J. Ophthalmol."},{"key":"ref_3","first-page":"965","article-title":"Clinical study of superior limbic keratoconjunctivitis associated with dysthyroid ophthalmopathy","volume":"54","author":"Nakashima","year":"2003","journal-title":"Folia Ophthalmol. Jpn."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1038\/s41433-018-0022-6","article-title":"Change in eyelid parameters after orbital decompression in thyroid-associated orbitopathy","volume":"32","author":"Park","year":"2018","journal-title":"Eye"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/S1367-0484(01)80015-1","article-title":"A novel instrument to quantify the tension of upper and lower eyelids","volume":"24","author":"Ehrmann","year":"2001","journal-title":"Cont. Lens Anterior Eye"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1038\/sj.eye.6701830","article-title":"Lower eyelid tensometry in younger and older normal subjects","volume":"20","author":"Francis","year":"2006","journal-title":"Eye"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"771","DOI":"10.3109\/02713683.2010.490320","article-title":"Topical cyclosporine in thyroid orbitopathy-related dry eye: Clinical findings, conjunctival epithelial apotosis, and MMP-9 expression","volume":"35","author":"Takmaz","year":"2010","journal-title":"Curr. Eye Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"739","DOI":"10.3129\/i07-141","article-title":"Effects of upper eyelid blepharoplasty on ocular surface sensation and tear production","volume":"42","author":"Kim","year":"2007","journal-title":"Can. J. Ophthalmol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1080\/01676830.2019.1600148","article-title":"Influence of surgical approach for decompression on lower eyelid position in thyroid eye disease","volume":"39","author":"Thorne","year":"2020","journal-title":"Orbit"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1472","DOI":"10.1016\/S0161-6420(95)30843-3","article-title":"Superior limbic keratoconjunctivitis: A prognostic sign for severe Graves ophthalmopathy","volume":"102","author":"Kadrmas","year":"1995","journal-title":"Ophthalmology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1717","DOI":"10.1007\/s40618-020-01258-w","article-title":"The European Group on Graves\u2019 Orbitopathy. Asymmetry indicates more severe and active disease in Graves\u2019 orbitopathy: Results from a prospective cross-sectional multicentre study","volume":"43","author":"Perros","year":"2020","journal-title":"J. Endocrinol. Investig."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"5288","DOI":"10.1038\/s41598-021-84661-4","article-title":"Tear film break-up patterns in thyroid eye disease","volume":"11","author":"Takahashi","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1136\/bjo.73.8.639","article-title":"Clinical criteria for the assessment of disease activity in Graves\u2019 ophthalmopathy: A novel approach","volume":"73","author":"Mourits","year":"1989","journal-title":"Br. J. Ophthalmol."},{"key":"ref_14","first-page":"e12830","article-title":"Relationship between eyelid pressure and lacrimal status in mild facial nerve palsy","volume":"13","author":"Lee","year":"2021","journal-title":"Cureus"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1537","DOI":"10.1001\/archopht.121.11.1537","article-title":"A novel grading method for superficial punctate keratopathy magnitude and its correlation with corneal epithelial permeability","volume":"121","author":"Miyata","year":"2003","journal-title":"Arch. Ophthalmol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1080\/01676830.2020.1745852","article-title":"Patency of the lacrimal drainage system in patients with a peripunctaltumour","volume":"39","author":"Kakutani","year":"2020","journal-title":"Orbit"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1080\/01676830.2019.1626446","article-title":"Patency of the lacrimal drainage system in patients with a peripunctaltumour","volume":"39","author":"Ishikawa","year":"2020","journal-title":"Orbit"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1397","DOI":"10.1007\/s10792-020-01305-8","article-title":"Postoperative changes in status of meibomian gland dysfunction in patients with involutional entropion","volume":"40","author":"Vaidya","year":"2020","journal-title":"Int. Ophthalmol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1097\/IOP.0000000000000235","article-title":"Meibomian gland dysfunction in cranial nerve VII palsy","volume":"31","author":"Takahashi","year":"2015","journal-title":"Ophthalmic Plast. Reconstr. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1016\/j.ajo.2005.11.004","article-title":"Marx line: Fluorescein staining line on the inner lid as indicator of meibomian gland function","volume":"141","author":"Yamaguchi","year":"2006","journal-title":"Am. J. Ophthalmol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1016\/j.ophtha.2007.06.031","article-title":"Noncontact infrared meibography to document age-related changes of the meibomian glands in a normal population","volume":"115","author":"Arita","year":"2008","journal-title":"Ophthalmology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1097\/IOP.0000000000001712","article-title":"Influential factors for changes in binocular single vision field and ocular deviation angle after balanced orbital decompression","volume":"37","author":"Vaidya","year":"2021","journal-title":"Ophthalmic Plast. Reconstr. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Lee, P.A.L., Vaidya, A., Kono, S., Kakizaki, H., and Takahashi, Y. (2021). Extraocular muscle expansion after deep lateral orbital wall decompression: Influence on proptosis reduction and its predictive factors. Graefes Arch. Clin. Exp. Ophthalmol., (Online ahead of print).","DOI":"10.1007\/s00417-021-05286-x"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Inoue, S., Kawashima, M., Arita, R., Kozaki, A., and Tsubota, K. (2020). Investigation of meibomian gland function and dry eye disease in patients with Graves\u2019 ophthalmopathy. J. Clin. Med., 9.","DOI":"10.3390\/jcm9092814"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e800","DOI":"10.1111\/aos.14000","article-title":"Dry eye syndrome in thyroid eye disease patients: The role of increased incomplete blinking and meibomian gland loss","volume":"97","author":"Park","year":"2019","journal-title":"Acta Ophthalmol."},{"key":"ref_26","first-page":"3440","article-title":"Radiotherapy for benign disorders: Current use in clinical practice","volume":"25","author":"Fionda","year":"2021","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2027","DOI":"10.1038\/s41598-019-38640-5","article-title":"Predictive factors of prognosis after radiation and steroid pulse therapy in thyroid eye disease","volume":"9","author":"Ito","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1186\/1748-717X-7-95","article-title":"Clinical outcomes of radiotherapy as initial local therapy for Graves\u2019 ophthalmopathy and predictors of the need for post-radiotherapy decompressive surgery","volume":"7","author":"Prabhu","year":"2021","journal-title":"Radiot. Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Napoli, P.E., Coronella, F., Satta, G.M., Galantuomo, M.S., and Fossarello, M. (2014). Evaluation of the adhesive properties of the cornea by means of optical coherence tomography in patients with meibomian gland dysfunction and lacrimal tear deficiency. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0115762"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1007\/s12024-019-00136-z","article-title":"Optical coherence tomography in forensic sciences: A review of the literature","volume":"15","author":"Nioi","year":"2019","journal-title":"Forensic. Sci. Med. Pathol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"151429","DOI":"10.1016\/j.aanat.2019.151429","article-title":"Location of the myoneural junction of the inferior oblique muscle: An anatomic study","volume":"227","author":"Valencia","year":"2020","journal-title":"Ann. 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