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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
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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.
Other Related Sites - The American Thyroid Association
- What is Thyroid Disease?
- Thyroid Foundation of Canada
- National Graves Disease Foundation
- 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
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