Therapy of Graves’ Ophthalmopathy

Abstract

As described in Chapter 18, the characteristic ophthalmopathy of Graves’ disease is marked by impaired eye muscle movement, periorbital edema, with or without actual proptosis. The exophthalmos may be unilateral early but usually becomes bilateral with time. With moderate to advancing severity, the proptosis will be accompanied by varying degrees of ophthalmoplegia and congestive oculopathy characterized by Chemosis, conjunctivitis, and periorbital swelling. The most dreaded potential complications are corneal ulceration, optic neuritis, and optic atrophy. When exophthalmos becomes more severe and progresses rapidly to this point, it has been termed “malignant exophthalmos”. The term exophthalmic ophthalmoplegia refers to the ocular muscle weakness that results in impaired upward gaze and convergence and strabismus with varying degrees of diplopia. Progressive ophthalmopathy is the most difficult component of Graves’ disease to treat successfully. Given four fixed bony orbital walls, the increased intraorbital contents (enlarged external ocular muscles due to lymphocytic infiltration and edema, increased retrobulbar fat) cause the globe to protrude outward causing proptosis. With limits to outward proptosis, pressure can be directed posteriorly on the optic nerve in its course between the bodies of the eye muscles causing ischemia and blindness. In its later stages, the external eye muscles and the levator palpebrae become fibrotic with resultant restricted movement leading to blurred vision, diplopia, and lid retraction. A consequence of lid retraction may be corneal drying and exposure keratitis and ulceration.KeywordsOptic NeuropathyExtraocular MuscleStrabismus SurgeryOrbital DecompressionOrbital FibroblastThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.