Clinical assessment of corneal alterations in endocrine disorders

Abstract

Corneal alterations are frequent in many endocrine disorders like Grave’s ophthalmopathy and diabetes mellitus. Since early diagnosis of such a change can prevent visual impairment, it presents a challenge to an ophthalmologist.Clinical assessment & significance of corneal alterations in endocrine disorders.1. To conduct comprehensive assessment of corneal alterations in endocrine disorders. 2. To Identify specific corneal abnormalities in patients with endocrine disorders. 3. To delineate the clinical significance of corneal alterations in endocrine disorders by determining their impact on visual function and guiding therapeutic strategies.This study was a prospective, observational, hospital-based study conducted over a period of two years including 150 patients of different endocrine disorders. Ocular examination included physical examination to check for any pain on ocular movements, ophthalmoplegia, diplopia, or proptosis. Visual acuity was examined by Snellen’s chart, anterior segment by slit-lamp, intra-ocular pressure by non-contact tonometer, qualitative measurement of corneal sensation by a cotton-wisp and central corneal thickness was measured by pachymetry. Corneal endothelial cell parameters like endothelial cell density (ECD), coefficient of variation of cell area (CV), percentage of hexagonal cell (HEX) were measured by clinical specular microscope.The age range was 14 to 82 years with mean age being 48.43±14.2 years. The male to female ratio was 1.34:1. Type-2 diabetes mellitus was the most frequently encountered endocrine disorder (64.7%), followed by hypothyroidism (13.3%). Addison’s disease was the least encountered (0.7%). The most severe changes to the cornea, such as chronic epithelial abnormalities, superficial punctate keratopathy, altered corneal sensations, and dry eyes, were observed in patients with type 2 diabetes, followed by Graves’s ophthalmopathy and hypothyroidism. Patients with T2DM and T1DM had elevated CCT values, reduced endothelial cell density, abnormally high coefficient of variance and low hexagonal cells.The present study showed that different corneal alterations can be possible in endocrine disorders. So all endocrine disorders should undergo comprehensive ophthalmological examination to prevent visual impairment.