THYROID OPTHALMOPATHY
THYROID OPHTHALMOPATHY (DISTHYROID OPHTHALMOPATHY)
- Thyroid ophthalmopathy, also c/d thyroid orbitopathy, is a disease of the orbit seen in Graves disease (thyrotoxicosis), therefore also c/d Graves ophthalmopathy.
- Characterised by enlargement of ocular flat & enlargement of extraocular muscles due to deposition of mucopolysaccharides.
Clinical features are:
- The most common & earliest symptom is upper eyelid retraction.
- Exopthalmos (Proptosis): Proptosis is the second most common symptom.
- Thyroid ophthalmopathy is the m/c cause of proptosis, whether unilateral or bilateral in adults.
Proptosis may be:
- Mild exopthalmos: in hyperthyroids (thyrotoxicosis, Graves disease)
- Extreme exoptalmos: in hypothyroidism
- Restrictive extraocular myopathy: Enlargement of extraocular muscle without enlargement of tendon is the hallmark of thyroid ophtalmopathy.
- Inferior rectus muscle (m/c involved).
- External ophtalmoplegia: Thyroid ophthalmopathy can cause vertical diplopia due to paralysis of vertical acting muscles like inferior oblique.
Ocular signs are:
- Bilateral exopthalmos with assoiated exposure keratitis
- Kocher’s sign: Staring & frightened appearance, especially marked on attentive fixation.
- Dalrymple’s sign: There is peculiar stare due to retraction of upper lid
- Von Graefe’s sign: Upper lid lags on downwards movements of the eyeball
- Stellwag’s sign: infrequent & incomplete blinking
- Mobius 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)
- Grifford’s sign: Difficulty in eversion of upper lid.
Exam Important
- The walls of the orbit which are removed in the two wall decompression for proptosis of thyroid ophthalmopathy include part of Orbital floor and medial wall
- Occurrence of diplopia, dysphagia, dysarthria, blurring of vision and muscle weakness could be due to Botulism
- Muscle mostly affected in thyroid ophthalmopathy is Inferior rectus
- Earliest symptom of thyroid ophthalmopathy is Lid retraction
- Most common cause of proptosis in adults is Thyroid Ophthalmopathy
- Sign of thyroid ophthalmopathy are Van Graefe’s sign , Dalrymple’s sign & Joffroy’s sing
- Most common ocular movement affected in thyroid ophthalmopathy Elevation
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