To compare the subjective versus Objective dry eye disease (DED) in patients with moderate-severe thyroid eye disease (TED).

Included were the patients with moderate-severe TED and ≥18 years old. They completed the ocular surface disease index (OSDI) questionnaire and had Schirmer, Tear breakup time (TBUT), fluorescein staining, osmolarity, corneal aesthesiometry, and meibomian gland dysfunction (MGD) tests. Excluded were patients with the history of any disease, surgery and or medications which might be affecting the ocular surface and incomplete tests results. Subjective DED was defined as OSDI score of ≥13 and objective as one abnormal sign (TBUT, Schirmer, Osmolarity, and Staining). Presence of both was defined as definite DED.

Included were 38 patients (74 eyes) with mean age of 40 years. Subjective DED was detected in 77%, objective in 89.2%, and definite in 67.7% of the eyes. Severe subjective and objective DED were found in 36.5% and 24.3% of the eyes, respectively. TBUT was the most frequent positive test (63.5%). MGD was observed in 56.8% of the eyes. Mean clinical activity score, palpebral fissure, rundle grading, proptosis, corneal aesthesiometry, and presence of MGD were not significantly different between the eyes with and without subjective, objective, or definite DED.

Definite DED was found in more than 2/3 of the eyes with moderate-severe TED. While frequency of objective DED was higher, severe form of subjective DED was more frequent. No variable was significantly different between the eyes with and without subjective, objective and definite DED.