II. Epidemiology

  1. Eye complications occur in 25-50% of Grave's Disease

III. 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

IV. 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

V. 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)

VI. Signs

VII. Imaging

  1. MRI or CT of orbits

VIII. 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

IX. Course

  1. Clinical findings may persist after Thyroid treated

Images: Related links to external sites (from Bing)

Related Studies

Ontology: Thyrotoxic exophthalmos (C0155265)

Concepts Disease or Syndrome (T047)
ICD9 376.21
SnomedCT 19885005
Dutch exoftalmie thyrotoxisch, exoftalmische thyreotoxicose, thyrotoxische exoftalmie
French Thyrotoxicose exophtalmique, Exophtalmie thyrotoxique, Exophtalmie maligne
German Exophthalmus durch Thyreotoxikose, Thyreotoxikose, Exophthalmus verursachend
Italian Esoftalmo tireotossico, Tireotossicosi esoftalmica
Portuguese Exoftalmo tirotóxico, Tirotoxicose exoftálmica
Spanish Exoftalmos tirotóxico, Tirotoxicosis exoftálmica, exoftalmos tirotóxico, exoftalmos tirotóxico (trastorno), exoftalmía hipertiroidea (trastorno), exoftalmía hipertiroidea
Japanese 眼球突出性甲状腺中毒症, 甲状腺中毒性眼球突出症, ガンキュウトッシュツセイコウジョウセンチュウドクショウ, コウジョウセンチュウドクセイガンキュウトッシュツショウ
English exophthalmic hyperthyroidism (diagnosis), exophthalmic hyperthyroidism, Thyrotoxic exophthalmos, Thyrotoxic exophthalmos (disorder), Exophthalmic thyrotoxicosis, Exophthalmos thyrotoxic
Czech Tyreotoxický exoftalmus, Exoftalmická tyreotoxikóza
Hungarian Exophthalmus hyperthyreotica, Hyperthyreoticus exophthalmus, Exophthalmicus hyperthyreosis

Ontology: Thyroid associated opthalmopathies (C0339143)

Definition (MSH) An autoimmune disorder of the EYE, occurring in patients with Graves disease. Subtypes include congestive (inflammation of the orbital connective tissue), myopathic (swelling and dysfunction of the extraocular muscles), and mixed congestive-myopathic ophthalmopathy.
Concepts Disease or Syndrome (T047)
MSH D049970 , D006111
ICD10 H06.2
SnomedCT 53061005, 415717005, 410725005, 148010005, 397553000, 194581002, 276177000
English Dysthyroid exophthalmos, Dysthyroid ophthalmopathy, Thyroid-assoc ophthalmopathy, OPHTHALMOPATHIES THYROID ASSOC, THYROID ASSOC OPHTHALMOPATHIES, OPHTHALMOPATHY THYROID ASSOC, THYROID ASSOC OPHTHALMOPATHY, Graves' ophthalmopathy (diagnosis), Graves Ophthalmopathy [Disease/Finding], dysthyroid eye disease, eye thyroid disease, thyroid eye disease, associated ophthalmopathy thyroid, grave ophthalmopathy, graves' ophthalmopathy, thyroid orbitopathy, endocrine exophthalmos, graves ophthalmopathy, Thyroid orbitopathy (disorder), Thyroid eye disease with exophthalmos (disorder), Graves eye disease (disorder), Thyroid eye disease with exophthalmos, Graves opthalmopathy, Dysthyroid ophthalmopathy (disorder), Thyroid eye disease, Thyroid eye disease (disorder), Thyroid associated opthalmopathies, Dysthyroid eye disease, Endocrine orbitopathy, Graves' ophthalmopathy, Ophthalmic Graves disease, Thyroid-associated ophthalmopathy, Thyroid orbitopathy, Graves ophthalmopathy, Graves eye disease, Graves' eye disease, Thyroid ophthalmopathy, Endocrine ophthalmopathy, Ophthalmopathies, Thyroid Associated, Ophthalmopathies, Thyroid-Associated, Ophthalmopathy, Thyroid Associated, Ophthalmopathy, Thyroid-Associated, Thyroid Associated Ophthalmopathies, Thyroid Associated Ophthalmopathy, Thyroid-Associated Ophthalmopathies, Thyroid-Associated Ophthalmopathy, Dysthyroid Ophthalmopathies, Dysthyroid Ophthalmopathy, Graves Ophthalmopathy, Ophthalmopathies, Dysthyroid, Ophthalmopathy, Dysthyroid, Ophthalmopathy, Graves, Dysthroid orbitopathy, Dysthyroid orbitopathy
Italian Oftalmopatia endocrina, Oftalmopatia associata alla tiroide, Oftalmopatie associate alla tiroide, Orbitopatia tiroidea, Oftalmopatia distiroidea, Oftalmopatia di Basedow, Oftalmopatia di Graves, Oftalmopatia di origine tiroidea
Dutch Graves-oftalmopathie, Dysthyroïde exoftalmie, endocriene oftalmopathie, Oftalmopathie, thyroid-geassociëerde, Thyroid-geassociëerde oftalmopathie
French Ophtalmopathie de Grave, Ophtalmopathie endocrine, Ophtalmopathie basedowienne, Ophtalmopathie de la maladie de Basedow, Ophtalmopathie dysthyroïdienne, Ophtalmopathie thyroidienne, Ophtalmopathies d'origine thyroïdienne
German Graves' Ophthalmopathie, Exophthalmus bei Funktionsstoerung der Schilddruese, endokrine Ophthalmopathie, Ophthalmopathie, schilddrüsenassoziierte, Schilddrüsenassoziierte Ophthalmopathie, Dysthyroide Ophthalmopathie, Graves-Ophthalmopathie, Ophthalmopathien, schilddrüsenassoziierte, Schilddrüsenassoziierte Ophthalmopathien
Portuguese Oftalmopatia de Grave, Oftalmopatia Tireoide-Associada, Oftalmopatia Associada à Tireoide, Oftalmologia endócrina, Oftalmopatia de Graves
Japanese グレーブス眼症, 内分泌性眼症, ナイブンピセイガンショウ, グレーブスガンショウ, ナイブンピツセイガンショウ, 甲状腺眼症, バセドウ眼症, グレーブズ病眼症, グレーヴズ病眼症, 甲状腺付隨眼障害, バセドウ病眼症, 甲状腺機能亢進性眼病変, 眼障害-甲状腺付随, 甲状腺性眼症, Graves病眼症, Basedow病眼症
Swedish Graves' oftalmopati
Czech Gravesova oftalmopatie, oftalmopatie spojená s tyreoideou, Endokrinní oftalmopatie
Finnish Basedowin tautiin liittyvä silmäsairaus
Russian GREIVSA OFTAL'MOPATIIA, OFTAL'MOPATIIA TIREOID-ASSOTSIIROVANNAIA, TIREOID-ASSOTSIIROVANNAIA OFTAL'MOPATIIA, OFTAL'MOPATIIA INFIL'TRATIVNAIA, ГРЕЙВСА ОФТАЛЬМОПАТИЯ, ОФТАЛЬМОПАТИЯ ИНФИЛЬТРАТИВНАЯ, ОФТАЛЬМОПАТИЯ ТИРЕОИД-АССОЦИИРОВАННАЯ, ТИРЕОИД-АССОЦИИРОВАННАЯ ОФТАЛЬМОПАТИЯ
Korean 갑상샘이상성 안구돌출증
Croatian GRAVESOVA OFTALMOPATIJA
Polish Oftalmopatia tarczycowa, Oftalmopatia Gravesa
Hungarian Graves' ophthalmopathia, Endocrin ophthalmopathia
Norwegian Endokrin oftalmopati, Graves' oftalmopati
Spanish orbitopatía tiroidea (trastorno), enfermedad ocular tiroidea con exoftalmos, enfermedad de Graves ocular (trastorno), enfermedad ocular tiroidea con exoftalmos (trastorno), orbitopatía tiroidea, Oftalmopatía Asociada a Tiroides, enfermedad ocular tiroidea (trastorno), enfermedad ocular tiroidea, Oftalmopatía endocrina, oftalmopatía de Graves, oftalmopatía tiroidea, enfermedad de Graves ocular, Oftalmopatía por Tiroides, Oftalmopatía Tiroidea, Oftalmopatía de Graves

Ontology: Thyroid associated orbitopathy (C3495928)

Concepts Disease or Syndrome (T047)
English Thyroid associated orbitopathy
Czech Orbitopatie při onemocnění štítné žlázy
Dutch met de schildklier geassocieerde orbitopathie
French Orbitopathie associée à la thyroïde
German schilddruesenbedingte Orbitopathie
Hungarian Pajzsmiriggyel összefüggő orbitopathia
Italian Orbitopatia associata alla tiroide
Japanese 甲状腺関連眼窩疾患, コウジョウセンカンレンガンカシッカン
Portuguese Orbitopatia associada à tiróide
Spanish Orbitopatía asociada al tiroides

Ontology: Ophthalmoplegia due to Graves disease (C3839430)

Concepts Pathologic Function (T046)
SnomedCT 104461000119104
English Ophthalmoplegia due to Graves disease, Ophthalmoplegia due to Graves' disease, Ophthalmoplegia due to Graves disease (disorder)