The effects of teprotumumab on volume of lacrimal glands and tear production were presented at ASOPRS 2021. Dry eye syndrome is a common cause of discomfort among individuals with thyroid eye disease and can occur in up to 85% of patients, investigators explained, while eyelid manipulation plays an important role in disrupting the ability of the eyelids to protect the ocular surface.

“Recent work has shown that mechanical factors, such as upper eyelid retraction, interpalpebral fissure distance, or proptosis, were not predictive of the development of [dry eye syndrome] in patients with chronic [thyroid eye disease]. Enlargement of the lacrimal gland in [thyroid eye disease] has been found to correlate with subjective tearing,” they added.

Individuals with thyroid eye disease were enrolled; those who were currently on treatment for the condition or received rituximab or tocilizumab in the past were excluded. In addition to change in volume of the lacrimal gland and production of tears after treatment with teprotumumab, the researchers also measured eyelid positions including margin-to-reflex distance (MRD), change in proptosis, and change in CAS.

“Tear secretion was measured by the Schirmer test in each eye for 5 minutes. The orbit with the worse proptosis was designated as the study orbit,” authors wrote.

Analyses showed:

  • Clinically, the mean CAS for the study eye was 5 (1.7) at baseline and 0.7 (0.8) post treatment
  • Lacrimal gland volume decreased from 751 (349) to 418 (134) mm3 following treatment in the study orbit (P < .01)
  • In the fellow orbit, mean lacrimal gland volume decreased from 576 (301) to 417 (134) mm3 (< .05)
  • Wetting in the study eye during Schirmer’s testing increased from 14.5 (10.5) mm at baseline to 22 (11) mm following treatment
  • There were no associations between MRD, proptosis, steroid use, and duration of TED with lacrimal gland volume or tear production

Overall, the study revealed teprotumumab significantly reduced TED–related expansion of the lacrimal gland and increased tear production. These changes were significant in patients with acute and chronic thyroid eye disease, the researchers concluded.

Ugradar S, Kim JS, Zimmerman E, Braun J, Mester T, Wang Y. Change in lacrimal gland volume and tear production following treatment with teprotumumab. Presented at: ASOPRS Fall Scientific Symposium; November 11-12, 2021; New Orleans, LA. https://asoprsfall.virtualbyvario.com/wp-content/uploads/2021/10/ASOPRS_2021_fall_syllabus_FINAL.pdf