Smokers More Likely to Face Surgery With Thyroid Eye Disease

Jenni Laidman

December 02, 2011

December 2, 2011 — Smokers with thyroid eye disease are twice as likely to require strabismus surgery as nonsmokers, further confirming the damaging role smoking plays in the autoimmune eye disease, according to a retrospective study published in the December issue of Ophthalmology.

Rathie Rajendram, MRCOphth, from the Orbital Unit, Moorfields Eye Hospital, London, United Kingdom, and colleagues examined the records of 425 of the hospital's thyroid eye disease patients who were seen by the same clinical team from 1997 through 2002. Researchers studied data for the 378 patients whose smoking status was recorded at initial presentation.

The age-adjusted analysis revealed that smokers were far more likely (hazard ratio [HR], 2.19) to require strabismus surgery to correct diplopia than nonsmokers. Among the patients in the study population, 83 required the surgery, including 19 of 138 (14%) nonsmokers and 51 of 196 (26%) active smokers. Seven of the 44 patients who had quit smoking in the last 5 years required surgery. Some patients underwent more than 2 operations.

Smokers who had not previously undergone decompression surgery were even more likely (HR, 4.86; 95% confidence interval [CI], 1.74 - 13.59; P < .01) to need strabismus surgery. Decompression surgery is often associated with need for future surgery, which this study confirms (HR, 4.0; 95% CI, 2.36 - 6.82; P < .001). However, the London researchers show that smokers who had decompression surgery had no greater risk for strabismus surgery (HR, 1.01; 95% CI, 0.58 - 1.77; P = .96) compared with nonsmokers. All figures are age adjusted.

The study adds to the evidence that a diagnosis of Graves' disease should be the cease-and-desist order for smoking.

"Although no prospective data are available on the effects of smoking cessation," the authors write, "these results suggest that clinicians should inform patients that smoking increases the frequency of ongoing rehabilitative surgery in thyroid eye disease and that it should be strongly discouraged in patients with Graves' disease who are at risk of thyroid eye disease or with eye involvement at presentation."

Smokers often suffer from a more severe and treatment-resistant form of thyroid eye disease. Previous studies revealed that although 93% of nonsmokers respond to glucocorticoids and orbital radiotherapy, only 68% of smokers respond.

The current study confirmed the prevalence of smokers among those with thyroid eye disease. Although 27% of adults in England smoke, according to 1998 government statistics, more than half of the study population smoked. The study included 196 (52%) smokers and 138 (36%) participants who quit smoking 5 or fewer years before presentation. Nonsmokers numbered 44 (12%) in the study population, meaning they never smoked or quit more than 5 years before presentation.

The study was supported by the UK National Institute for Health Research Biomedical Research Centre in Ophthalmology at Moorfields Eye Hospital and the UCL Institute of Ophthalmology. The authors have disclosed no relevant financial relationships.

Ophthalmology. 2011;118:2493-2497. Abstract


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