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Thyroid Eye Disease

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Thyroid Eye Disease, Hyperthyroidism Related Infiltrative Ophthalmopathy, Ophthalmoplegia Due to Grave's Disease, Thyroid Associated Ophthalmopathy, Grave's Ophthalmoplegia, Graves Proptosis, Graves Exophthalmos, Thyrotoxic Exophthalmos, Graves Orbitopathy

  • See Also
  1. Hyperthyroidism
  2. Grave's Disease
  • Epidemiology
  1. Eye complications occur in 25-50% of Grave's Disease
  • Pathophysiology
  1. Grave's Disease induced eye changes
    1. Sensitized orbital tissue-specific T-Lymphocytes
    2. Local inflammatory cellular infiltration of eye
  2. Orbital fibroblasts mediate changes
    1. Adipose hypertrophy
    2. Glycosaminoglycan accumulates
  3. Residual scarring may cause irreversible Proptosis
  • Risk Factors
  1. Tobacco Abuse (Relative Risk 3.7)
  2. Older men appear to have more severe cases
  3. Radioiodine therapy may cause flare in eye disease
    1. Prednisone used to prevent flare
      1. Dose: 40 to 80 mg daily
      2. Taper off over 3 months
  • Symptoms
  1. Diplopia (33%)
  2. Ocular pain (30%)
    1. Pressure Sensation on or behind globe
    2. Worse with Extraocular Movement
  3. Excessive Lacrimation or Epiphora (21%)
  4. Photophobia (16%)
  5. Blurred Vision (9%)
  6. Eye irritation (gritty Sensation, Eye Foreign BodySensation)
  • Signs
  1. Eyelid Retraction (91%)
  2. Proptosis or Exophthalmos (62%)
  3. Extraocular Movement dysfunction (42%)
  4. Conjunctival Hyperemia (34%)
  5. Eyelid Edema (32%)
  6. Chemosis 23%
  7. Optic Neuropathy (6%)
  • Imaging
  1. MRI or CT of orbits
  • Management
  1. Manage Grave's Disease
  2. Refer all cases to ophthalmology
  3. Treatment used by ophthalmology in mod. to severe cases
    1. High dose Corticosteroids
    2. Orbital decompression
  • Course
  1. Clinical findings may persist after Thyroid treated
  • References
  1. Cawood (2004) BMJ 329:385-90 [PubMed]
  2. Kravets (2016) Am Fam Physician 93(5): 363-70 [PubMed]
  3. Sahli (2017) Turk J Ophthalmol 47(2):94-105 +PMID: 28405484 [PubMed]