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Thyroid Eye Disease
Aka: Thyroid Eye Disease, Hyperthyroidism Related Infiltrative Ophthalmopathy, Ophthalmoplegia Due to Grave's Disease, Grave's Ophthalmoplegia, Graves Proptosis, Graves Exophthalmos, Graves Orbitopathy
- See Also
- Hyperthyroidism
- Grave's Disease
- Epidemiology
- Eye complications occur in 25-50% of Grave's Disease
- 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
- 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
- Symptoms
- Ocular pain
- Pressure Sensation on or behind globe
- Worse with Extraocular Movement
- Photophobia
- Chemosis
- Excessive Lacrimation
- Diplopia
- Proptosis (Exophthalmos)
- Eye irritation (gritty Sensation, Eye Foreign BodySensation)
- Signs
- Proptosis (Exophthalmos)
- Eyelid and Conjunctiva edema and redness
- Radiology
- MRI or CT of orbits
- Management
- Manage Grave's Disease
- Refer all cases to ophthalmology
- Treatment used by ophthalmology in mod. to severe cases
- High dose Corticosteroids
- Orbital decompression
- Course
- Clinical findings may persist after Thyroid treated
- References
- Cawood (2004) BMJ 329:385-90 [PubMed]
- Kravets (2016) Am Fam Physician 93(5): 363-70 [PubMed]