Thyrotropic Exophthalmos Research Articles

Letter: The fetus and maternal steroid therapy.

ABSTRACT To the Editor.— I read with interest in the QUESTIONS AND ANSWERS section (230:1202, 1974) the note entitled What Risk to Fetus from Maternal Steroid Therapy. A 33-year-old woman had acute thyrotropic exophthalmos with euthyroidism in the fifth month of pregnancy. She required large doses of steroids to control her eye problem, and was given prednisone, 100 mg/day, orally. The question of risks to the fetus was raised, and the follow-up note reported that the patient did have a child who had hydrocephalus requiring surgery at 2 months of age.I should like to point out that this patient was an ideal candidate to have been treated with steroids administered in the sub-tenon space. A single injection of triamcinolone acetonide (Kenalog), 40 mg/ml to both orbits, would have controlled her eye problem for two to six weeks, in my experience, and would have totally obviated the necessity for maintaining her

Lecture Notes on Ophthalmology

A remarkable amount of material has been compressed into this short textbook. It is astonishing to find that almost any subject that occurs to the reader is covered somewhere in this book. If there is any criticism to be made, it is that perhaps some things have been included which are outside the scope of such a book. For example, the illustration of the technique of recession of the medial rectus hardly gives the senior medical student an appreciation of the technique involved in this procedure. A similar objection can be made to the illustrations on cataract extraction and trephine operation for glaucoma. Finally, the illustrations for thyrotropic exophthalmos and of enucleation of the eye are straight out of Grand Guignol. They undoubtedly have great dramatic value, but they are enough to frighten even the hardened ophthalmologist, let alone the poor senior medical student. These are minor objections and, all

Transantral decompression for malignant exophthalmos.

Our topic is Transantral Decompression for Malignant Exophthalmos. As the title indicates, this is another example in the ever-widening field of otolaryngology. If the welfare of the patient is served, diversification is permissible. It is our firm belief that the otolaryngologist can offer substantial aid to the patient suffering from malignant exophthalmos. Despite tremendous advances in diagnostic methods and therapeutic procedures available for the management of Graves' disease, exophthalmos remains its most baffling and least understood component. Differentiation into thyrotoxic and thyrotropic (malignant) exophthalmos serves a useful purpose from the clinical standpoint. Thyrotoxic exophthalmos is a relatively mild involvement characterized by a slight compressible type of ocular protrusion, lid retraction, and possibly some thinning of the extraocular muscles. Except for the undesirable cosmetic effect the condition is harmless and the prognosis favorable. Our discussion deals with thyrotropic exophthalmos (also described as malignant, progressive, or endocrine exophthalmos, hyperophthalmos of Graves' disease,

A new operation for decompression in malignant exophthalmos.

Malignant exophthalmos is a pathological entity. It is also described as exophthalmic ophthalmoplegia, progressive exophthalmos, or thyrotropic exophthalmos. The last name seems to be most suitable, as it indicates not only the disease but also the presumable cause of this condition. Symptomatology The onset is usually insidious. Patients complain of lacrimation, photophobia, and protrusion of the eyeballs, which may achieve extreme grades. There are swelling and inflammation of the conjunctiva, often associated with prolapse of the conjunctival sac. Defective eye closure causes secondary changes in the cornea. Characteristic are pathological changes in the eye muscles in the form of degeneration of muscle fibers, fragmentation of fibers and round-cell infiltration. The associated muscle palsies mostly involve the rectus superior on one or both sides with diplopia, or without if both sides are involved. Owing to increased volume of the muscles (3 to 8 times that of the normal volume and length)

A new symptom of thyrotropic exophthalmos; reduction of ocular rigidity

A new symptom of thyrotropic exophthalmos; reduction of ocular rigidity

Injection of Hyaluronidase into the Anterior Chamber of the Rabbit Eye

Since the isolation of hyaluronidase from bovine vitreous in 1934, various ophthalmologic uses for this preparation have been sug­ gested. Akinesia as produced by either the O'Brien or Van Lint method has been found to be more rapid, certain, and profound when hyaluronidase is added to the procaineepinephrine combination. In surgical proced­ ures in which retrobulbar anesthesia is to be used, particularly in cases where a lowering of the intraocular pressure is desired, the ad­ dition of hyaluronidase has been helpful. It has also been incorporated in retrobulbar injection to reduce the ocular pressure in acute glaucoma. Retrobulbar injection of hyaluronidase has been recommended to re­ duce the edema of the orbital tissues associ­ ated with thyrotropic exophthalmos. Hyaluronidase has been used subconjunctivally to reduce hypopyon associated with corneal ulcers and to increase the penetration and absorption of antibiotics administered subconjunctivally. It also has been of value when added to the subconjunctival injection of cocaine-epinephrine and atropine for the releasing of posterior synechias. It has been suggested that following in­ adequate filtering operations for glaucoma subconjunctival injections of five-150 turbid­ ity-reducing units may increase the efficiency of drainage. Transient and variable improve­ ment has been reported from subconjuncti­ val administration of hyaluronidase in at­ tempts to clear corneal edema, scars, opaci­ ties, and blood vessels. Tassman found that 150 turbidity units of hyaluronidase instilled into the conjunctival sac produces almost immediate improvement

Visual changes in progressive exophthalmos.

PROGRESSVIE exophthalmos is often called "malignant" exophthalmos, and it is sometimes referred to as exophthalmic ophthalmoplegia (Brain¹²), thyrotropic exophthalmos (Mulvany¹⁸), and a hyperophthalmopathic type of Graves's disease (Means¹⁶). In contrast to the slight exophthalmos of goiter, which may be combined with some staring, the malignant type is characterized by its progressive nature; periorbital and lid edema; diminution or lack of resiliency, elicited by palpating the eyeball; limitation of ocular motility, often causing diplopia, and retraction of the upper lid, resulting in staring. In some cases thyrotoxicosis precedes this exophthalmos, but usually by the time there are signs of progressive exophthalmos the thyroid condition is well controlled or has reached the stage of hypothyroidism; occasionally there is no thyroid history whatsoever. Fortunately, malignant exophthalmos occurs infrequently, for it is a disabling and dangerous disease and a great burden to the patient, as well as to the physician, particularly

LID MOBILIZATION AND TARSORRHAPHY FOR MASSIVE PROPTOSIS

THERE ARE several types of massive proptosis which constitute a dangerous threat to the eye. In such cases the cornea is exposed because the lids cannot close over it. This is followed by exposure keratitis, which may terminate in serious loss of vision, or even in loss of the eye. For a mild degree of corneal exposure there are a number of well-known techniques available, such as production of marginal lid adhesions and the Fuchs, Wheeler, and Kuhnt-Szymanowsky tarsorrhaphies. However, in the massive proptosis which may be encountered with some cases of thyrotropic exophthalmos, especially with orbital tumors, these measures may not be sufficient to protect the globe. Even when they are attempted in such cases, the lid sutures give way under the pressure and the cornea is again exposed. The procedure to be described has the great advantage that it produces a firm tarsorrhaphy and secures protection for the

HYPEROPHTHALMOPATHIC GRAVES'S DISEASE

THE PURPOSE of this report is to describe the clinical course of 19 patients with hyperophthalmopathic Graves's disease followed for periods varying from ½ to 20 years. The classification and relation to thyroid dysfunction are considered in the light of this experience. The ocular manifestations which we have chosen to call the hyperophthalmopathic phenomena of Graves's disease are also known by several other names: malignant, progressive, or postoperative exophthalmos; exophthalmic ophthalmoplegia; the ophthalmopathic form of Graves's disease, and thyrotropic exophthalmos. The current concept of Graves's disease has been aptly summarized by Means 1 as follows: Graves' disease, therefore, may be defined as a constitutional disturbance of unknown origin, characterized in its full-blown classic form by hyperplasia of the thyroid, hyperthyroidism or thyrotoxicosis, and an utterly unique type of ophthalmopathy, together with widespread changes in other systems of the body. Many cases fulfill all these requirements; some only a portion of

The Ocular Changes in Thyrotropic Exophthalmos

The Ocular Changes in Thyrotropic Exophthalmos

HYPEROPHTHALMOPATHIC SYNDROME IN THYROID DISEASE

IN RECENT years attention has been redirected to cases of thyrotoxicosis with predominance of ophthalmic manifestations. The latter include proptosis, paresis of external ocular muscles, swelling of the lids, edema of the conjunctivae and retrobulbar pain. A variety of designations has been applied to this syndrome, such as “malignant exophthalmos” and “exophthalmic ophthalmoplegia.” These terms are purely descriptive and stress one or another feature of the syndrome, not all of which are present in every case. Recently two other terms have been suggested. Mulvany (12) speaks of “thyrotropic exophthalmos” a term that is objectionable on linguistic grounds since the author evidently does not wish to imply that the exophthalmos is thyrotropic but that it is caused by thyrotropic hormone. It would then be thyrotropogenic rather than thyrotropic. Means (9) speaks of “hyperophthalmopathic Graves' disease.” Mulvany's term implies a very definite opinion as to the genesis of the syndrome whereas Means is deliber...

So-called Thyrotropic Exophthalmos

So-called Thyrotropic Exophthalmos