II. Epidemiology
- Eye complications occur in 25-50% of Grave's Disease
III. Pathophysiology
-
Grave's Disease induced eye changes
- Sensitized orbital tissue-specific T-Lymphocytes
- Local inflammatory cellular infiltration of eye
- Orbital fibroblasts mediate changes
- Adipose hypertrophy
- Glycosaminoglycan accumulates
- Residual scarring may cause irreversible Proptosis
IV. Risk Factors
- Tobacco Abuse (Relative Risk 3.7)
- Older men appear to have more severe cases
-
Radioiodine therapy may cause flare in eye disease
- Prednisone used to prevent flare
- Dose: 40 to 80 mg daily
- Taper off over 3 months
- Prednisone used to prevent flare
V. Symptoms
- Diplopia (33%)
- Ocular pain (30%)
- Pressure Sensation on or behind globe
- Worse with Extraocular Movement
- Excessive Lacrimation or Epiphora (21%)
- Photophobia (16%)
- Blurred Vision (9%)
- Eye irritation (gritty Sensation, Eye Foreign BodySensation)
VI. Signs
- Eyelid Retraction (91%)
- Proptosis or Exophthalmos (62%)
- Extraocular Movement dysfunction (42%)
- Conjunctival Hyperemia (34%)
- Eyelid Edema (32%)
- Chemosis 23%
- Optic Neuropathy (6%)
VII. Imaging
- MRI or CT of orbits
VIII. Management
- Manage Grave's Disease
- Refer all cases to ophthalmology
- Treatment used by ophthalmology in mod. to severe cases
- High dose Corticosteroids
- Orbital decompression
IX. Course
- Clinical findings may persist after Thyroid treated