Graves Ophthalmopathy (Thyroid Eye Disease)

Posted by e-Medical PPT Saturday, October 23, 2010
Graves' ophthalmopathy is an autoimmune inflammatory disorder affecting the orbit around the eye, characterized by eyelid retraction,exophthalmos,swelling,redness,conjunctivitis and proptosis.The autoantibodies target the fibroblasts in the eye muscles, and those fibroblasts can differentiate into fat cells. Fat cells and muscles expand and become inflamed. Veins become compressed, and are unable to drain fluid, causing edema.
In mild disease, patients present with eyelid retraction. In fact, upper eyelid retraction is the most common ocular sign of Graves' orbitopathy. This finding is associated with lid lag on infraduction,eye globe lag on supraduction, a widened palpebral fissure during fixation and an incapacity of closing the eyelids completely (lagophthalmos). Due to the proptosis, eyelid retraction and lagophthalmos, the cornea is more prone to dryness and may present with chemosis, punctate epithelial erosions and superior limbic keratoconjunctivitis. The patients also have a dysfunction of the lacrimal gland with a decrease of the quantity and composition of tears produced.Periorbital swelling due to inflammation can also be observed.
In moderate active disease, the signs and symptoms are persistent and increasing and include myopathy. The inflammation and edema of the extraocular muscles lead to gaze abnormalities.Patient may experience vertical diplopia on upgaze and limitation of elevation of the eyes due to fibrosis of the muscle.
In more severe and active disease, mass effects and cicatricial changes occur within the orbit. With enlargement of the extraocular muscle at the orbital apex, the optic nerve is at risk of compression. The orbital fat or the stretching of the nerve due to increased orbital volume may also lead to optic nerve damage. The patient experiences a loss of visual acuity, visual field defect, afferent pupillary defect, and loss of color vision.

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