Thyroid-associated ophthalmopathy is one of the most typical symptoms of Graves' disease. It is known by a variety of terms, the most common being Graves' ophthalmopathy. Thyroid eye disease is an inflammatory condition, which affects the orbital contents including the extraocular muscles and orbital fat. It is almost always associated with Graves' disease but may rarely be seen in Hashimoto's thyroiditis, primary hypothyroidism, or thyroid cancer.
The ocular manifestations that are relatively specific to Grave's disease include soft tissue inflammation, proptosis (protrusion of one or both globes of the eyes), corneal exposure, and optic nerve compression.
In order to assess proptosis (how much the eyes are pushed forward), a device called a hertel exophthalmometer (see below) is utilized.
Although these measurements may vary considerably from one doctor's measurements to another, they may provide you doctor some guidance as to progression of your disease.
Your eyes may move at different rates. The protrusion is caused by
swelling behind your eye where your eye muscles are located which pushes the eye itself forward.
increase fat and fullness of the fat
There is no other place for your eye to move but outward.
Eye proptosis can start before, during or after your diagnosis with Grave's Disease.
Graves Disease
Grave's Ophthalmolopathy is the most common caused of unilateral or bilateral proptosis in adults.
It commonly occurs between the ages of 25-50, although it may also present in adolescents.
Diagnosis is made based on clinical findings including proptosis, eyelid retraction, restrictive myopathy and possibly compressive optic neuropathy. It is often grouped into two independent manifestations of this syndrome:
Type I and Type II orbitapathy, but may overlap
More frequent signs:
Less frequent signs:
lid lag (upper and lower)
exophthalmos
diplopia
lid edema
chemosis
conj injection over recti
increased IOP with elevation
keratopathy
closed lid tremor
infrequent blinking
difficult eversion upper lid
bruit over eye
decrease forehead wrinkling with upgaze
increased hippus
pigmented lids
Werner's Classification
NO SPECS, with each class in four grades 0-4, a, b, c: mild to severe
0 No S/S
1 Only signs (lid retraction)
2 Soft tissue involved (chemosis, grit, etc)
3 Proptosis (min <23, mod, marked >28)
4 EOM involved
5 Corneal involvement
6 Sight loss
Symptom
Type I
Type II
Sex predilection
Female
Proptosis
Symmetric
Unilateral or bilateral
Eyelid retraction
Symmetric
Unilateral or bilateral
Orbital inflammation
Minimal
Extraocular muscle inflammation/ restriction
Minimal
Frequent
Chemosis
Unusual
Usual
diplopia
Unusual
Frequent
Compressive optic neuropathy
Unusual
Frequent
Diagnosis is made on these clinical findings and may be confirmed on CT which shows enlargement of multiple extraocular muscles most commonly the inferior and medial rectus. See earlier page.
Systemic thyroid may be hyperthyroid, hypothyroid, or euthyroid. Treatment may include topical lubrication, systemic steroids, orbital decompression surgery, extraocular muscle adjustment, eyelid recession surgery and radiation therapy.
Mailing list discusses all types of thyroid conditions. Family and friends of those with thyroid disease are welcome. The Thyroid discussion includes, but is not limited to, these conditions: Basedow's disease, Flajani's disease, goiter, Grave's disease, Hashimoto's disease, hypothyroid, hyperthyroid, myxedema, Parry's disease, struma, thyroiditis, thyroid nodules, and Wilson's syndrome. To join send an e-mail message to: listserv@maelstrom.stjohns.edu In the body of the message type: Subscribe Thyroid Your Name
