Thyroid Opthalmopathy

THYROID OPTHALMOPATHY

Q. 1

The walls of the orbit which are removed in the two wall decompression for proptosis of thyroid ophthalmopathy include part of:

 A

Orbital floor and medial wall

 B

Orbital floor and lateral wall

 C

Orbital roof and medial wall

 D

Medial and lateral walls

Q. 1

The walls of the orbit which are removed in the two wall decompression for proptosis of thyroid ophthalmopathy include part of:

 A

Orbital floor and medial wall

 B

Orbital floor and lateral wall

 C

Orbital roof and medial wall

 D

Medial and lateral walls

Ans. A

Explanation:

Ans. Orbital floor and medial wall


Q. 2

Occurrence of diplopia, dysphagia, dysarthria, blurring of vision and muscle weakness could be due to:

 A

Diphtheria

 B

Botulism

 C

Infantile beriberi

 D

Myasthenia gravis

Q. 2

Occurrence of diplopia, dysphagia, dysarthria, blurring of vision and muscle weakness could be due to:

 A

Diphtheria

 B

Botulism

 C

Infantile beriberi

 D

Myasthenia gravis

Ans. B

Explanation:

Ans.Botulism


Q. 3

Muscle mostly affected in thyroid ophthalmopathy is:

 A

Lateral rectus

 B

Inferior rectus

 C

Superior rectus

 D

Medial rectus

Q. 3

Muscle mostly affected in thyroid ophthalmopathy is:

 A

Lateral rectus

 B

Inferior rectus

 C

Superior rectus

 D

Medial rectus

Ans. B

Explanation:

Ans. Inferior rectus


Q. 4

Muscle to be affected commonly in thyroid ophthalmopathy is:

 A

Superior rectus

 B

Inferior rectus

 C

Superior oblique

 D

Inferior  oblique

Q. 4

Muscle to be affected commonly in thyroid ophthalmopathy is:

 A

Superior rectus

 B

Inferior rectus

 C

Superior oblique

 D

Inferior  oblique

Ans. B

Explanation:

Ans. B: Inferior rectus

In moderate active thyroid ophthalmopathy, the signs and symptoms are persistent and increasing and include myopathy. The inflammation and edema of the extraocular muscles lead to gaze abnormalities.

The inferior rectus muscle is the most commonly affected muscle and patient may experience vertical diplopia on upgaze and limitation of elevation of the eyes due to fibrosis of the muscle.


Q. 5

Earliest symptom of thyroid ophthalmopathy ‑

 A

Proptosis

 B

Lid retraction

 C

Ophthalmoplegia

 D

Diplopia

Q. 5

Earliest symptom of thyroid ophthalmopathy ‑

 A

Proptosis

 B

Lid retraction

 C

Ophthalmoplegia

 D

Diplopia

Ans. B

Explanation:

Ans. is ‘b’ i.e., Lid retraction

Thyroid ophthalmopathv

  • Thyroid ophthalmopathy, also called thyroid orbitopathy, is a disease of the orbit seen in Graves disease (thyrotoxicosis), therefore also called Graves ophthalmopathy. However it may also occur rarely in Euthyroid person, primary hyperthyroidism and Hashimoto’s thyroiditis. Thyroid ophthalmopathy is characterized by enlargement of ocular fat and enlargement of extraocular muscles due to deposition of mucopolysaccharides.
  • Clinical features are :-
  • The most common and earliest symptom is upper eyelid retraction.
  • Exophthalmos (Proptosis) Proptosis is the second most common symptom.Thyroid ophthalmopathy is the most common cause of proptosis, whether unilateral or bilateral in adults. Proptosis may be :-
  1. Mild exophthalmos :- In hyperthyroidis (thyrotoxicosis, Graves disease)
  2. Extreme exophthalmos :- In hypothyroidism
  • Restrictive extraocular myopathy :- Enlargement of extraocular muscle without enlargement of tendon is the hallmark of thyroid ophthalmopathy. This distribution of extraocular muscle swelling is typical of thyroid ophthalmopathy. The extraocular muscles involvement in order of decreasing frequency is : Inferior rectus (most commonly involved)> Medial rectus > Superior rectus > Lateral rectus > obliques. It is worth noting that this is restrictive myopathy and the muscle becomes thickened & scarred with deviation of eye towards the direction of action of muscle and there is restriction of movement in the direction opposite to the action of the involved muscle, though the opposite muscle is normal. For example in medial rectus involvement eye may be deviated medial and abduction will be restricted though the lateral rectus is normal.
  • External ophthalmoplegia :- Thyroid ophthalmopathy can cause vertical diplopia due to paralysis of vertical acting muscles like inferior oblique.

Q. 6

Most common cause of proptosis in adults is ‑

 A

Orbital cellulitis

 B

Thyroid Ophthalmopathy

 C

Carotico – cavernous fistula

 D

Trauma

Q. 6

Most common cause of proptosis in adults is ‑

 A

Orbital cellulitis

 B

Thyroid Ophthalmopathy

 C

Carotico – cavernous fistula

 D

Trauma

Ans. B

Explanation:

Ans. is ‘b’ i.e., Thyroid Ophthalmopathy

  • The most common cause of unilateral proptosis in children is orbital cellulitis.
  • The most common cause of unilateral proptosis in adults is thyroid ophthalmopathy.

Q. 7

Most common cause of the condition marked by a red arrow in adults is ? 

 A

Orbital cellulitis.

 B

Thyroid Ophthalmopathy.

 C

Carotico – cavernous fistula.

 D

Trauma.

Q. 7

Most common cause of the condition marked by a red arrow in adults is ? 

 A

Orbital cellulitis.

 B

Thyroid Ophthalmopathy.

 C

Carotico – cavernous fistula.

 D

Trauma.

Ans. B

Explanation:

The condition shown in the picture above represents proptosis.

Most common cause of proptosis in adults is thyroid Ophthalmopathy.

  • The most common cause of unilateral proptosis in children is orbital cellulitis.
  • The most common cause of unilateral proptosis in adults is thyroid ophthalmopathy.

Q. 8

Condition (arrow) shown in the photograph below is not seen in ? 

 A

Myasthenia gravis.

 B

Thyroid Ophthalmopathy.

 C

Lid tumors

 D

Multiple Sclerosis

Q. 8

Condition (arrow) shown in the photograph below is not seen in ? 

 A

Myasthenia gravis.

 B

Thyroid Ophthalmopathy.

 C

Lid tumors

 D

Multiple Sclerosis

Ans. B

Explanation:

Ans:B.)Thyroid Ophthalmopathy

The condition shown in the picture above represents Unilateral Ptosis.

PTOSIS

  • Abnormal drooping of the upper eyelid is called ptosis.
  • Normally, upper lid covers about upper one-sixth of the cornea, i.e., about 2 mm. Therefore, in ptosis it covers more than 2 mm.

Types and etiology
I. Congenital ptosis
It is associated with congenital weakness (maldevelopment) of the levator palpebrae superioris(LPS). It may occur in the following forms:

  • 1. Simple congenital ptosis (not associated with any other anomaly) .
  • 2. Congenital ptosis with associated weakness of superior rectus muscle.
  • 3. As a part of blepharophimosis syndrome, which comprises congenital ptosis, blepharophimosis, telecanthus and epicanthus inversus .
  • 4. Congenital synkinetic ptosis (Marcus Gunn jawwinking ptosis). In this condition there occurs retraction of the ptotic lid with jaw movements i.e., with stimulation of ipsilateral pterygoid muscle.

II. Acquired ptosis

  • 1. Neurogenic ptosis. It is caused by innervational defects such as third nerve palsy, Horner’s syndrome, ophthalmoplegic migraine and multiple sclerosis.
  • 2. Myogenic ptosis. It occurs due to acquired disorders of the LPS muscle or of the myoneural junction. It may be seen in patients with myasthenia gravis, dystrophia myotonica, ocular
  • myopathy, oculo-pharyngeal muscular dystrophy and following trauma to the LPS muscle.
  • 3. Aponeurotic ptosis. It develops due to defects of the levator aponeurosis in the presence of a normal functioning muscle. It includes involutional (senile) ptosis, postoperative ptosis (which is rarely observed after cataract and retinal detachment surgery), ptosis due to aponeurotic weakness associated with blepharochalasis, and in traumatic dehiscence or disinsertion of the aponeurosis.
  • 4. Mechanical ptosis. It may result due to excessive weight on the upper lid as seen in patients with lid tumours, multiple chalazia and lid oedema. It may also occur due to scarring (cicatricial ptosis)
  • as seen in patients with ocular pemphigoid and trachoma.

Q. 9

Sign of thyroid ophthalmopathy ‑

 A

Van Graefe’s sign

 B

Dalrymple’s sign

 C

Joffroy’s sing

 D

All of the above

Q. 9

Sign of thyroid ophthalmopathy ‑

 A

Van Graefe’s sign

 B

Dalrymple’s sign

 C

Joffroy’s sing

 D

All of the above

Ans. D

Explanation:

Ans. is ‘d’ i.e., All of the above

 Signs of thyroid ophthalmopathy are –

  • Bilateral exophthalmos with associated exposure keratitis.
  • Dalrymple’s sign – There is peculiar stare due to retraction of the upper lid
  • Von Graefe’s sign – Upper lid lags on downward movments of the eyeball
  • Stellwags sign – There is infrequent and incomplete blinking
  • Mobius c sign – There is weakness of convergence
  • Jellinek’s sign – There is increased pigmentation of lids.
  • Joffroy’s sign – There is poor forehead wrinking on looking up
  • Enroth’s sign – Fullness of eyelids (Puffy edematous)
  • Griffbrd’s sign – Difficulty in eversion of upper lid.

Q. 10

Most common ocular movement affected in thyroid ophthalmopathy‑

 A

Adduction

 B

Abduction

 C

Elevation

 D

Depression

Q. 10

Most common ocular movement affected in thyroid ophthalmopathy‑

 A

Adduction

 B

Abduction

 C

Elevation

 D

Depression

Ans. C

Explanation:

Ans. is ‘c’ i.e., Elevation 

  • Most commonly muscles involved in thyroid ophthalmopathy is inferior rectus, which becomes fibrotic and thickened. Thus, eyeball is depressed and elevation is not possible.

Thyroid ophthalmopathy

  • Thyroid ophthalmopathy, also called thyroid orbitopathy, is a disease of the orbit seen in Graves disease (thyrotoxicosis), therefore also called Graves ophthalmopathy. However it may also occur rarely in Euthyroid person, primary hyperthyroidism and Hashimoto’s thyroiditis. Thyroid ophthalmopathy is characterized by enlargement of ocular fat and enlargement of extraocular muscles(PG‘”) due to deposition of mucopolysaccharides.

Clinical features are :-

  • The most common and earliest symptom is upper eyelid retraction.
  •  Exophthalmos (Proptosis) Proptosis is the second most common symptom.Thyroid ophthalmopathy is the most common cause of proptosis, whether unilateral or bilateral in adults. Proptosis may be :- i) Mild exophthalmos :- In hyperthyroidis (thyrotoxicosis, Graves disease)
  • Extreme exophthalmos :- In hypothyroidism’ 

Restrictive extraocular myopathy :- Enlargement of extraocular muscle without enlargement of tendon is the hallmark of thyroid ophthalmopathy. This distribution of extraocular muscle swelling is typical of thyroid ophthalmopathy. The extraocular muscles involvement in order of decreasing frequency is : Inferior rectus (most commonly involved)> Medial rectus > Superior rectus‹ Lateral rectus< obliques. It is worth noting that this is restrictive myopathy and the muscle becomes thickened & scarred with deviation of eye towards the direction of action of muscle and there is restriction of movement in the direction opposite to the action of the involved muscle, though the opposite muscle is normal. For example in medial rectus involvement eye may be deviated medial and abduction will be restricted though the lateral rectus is normal

 External ophthalmoplegia :- Thyroid ophthalmopathy can cause vertical diplopia due to paralysis of vertical acting muscles like inferior oblique.



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