The Management of Metabolic Malignant Exophthalmos

Abstract

Despite the combined efforts of internist and ophthalmologist, the sequelae of metabolic malignant exophthalmos are often disastrous. The purpose of this paper is to outline a course of action that will minimize visual loss, ocular discomfort, and cosmetic debility. Because the ophthalmologist is frequently consulted after irreversible changes have occurred, the early ocular examination of patients with thyrotoxicosis should be stressed. This should include visual acuity, refraction, pupillary responses, Hertel exophthalmometer readings, motor and visual fields, intraocular and retrobulbar pressures, and an evaluation of the optic nerve and retina. Thus, one establishes a baseline for future comparisons. Loss of vision may occur secondarily to exposure keratopathy or damage to the optic nerve and retina from increased retrobulbar pressure. The normally bulgy eyed person usually develops the complication of corneal exposure whereas the individual with deepset eyes will develop optic nerve and chorioretinal pathology. Both conditions require drastic and uncompromising action