II. Epidemiology

  1. Eye complications occur in 25-50% of Grave's Disease

III. Pathophysiology

  1. Grave's Disease induced eye changes
    1. Sensitized orbital tissue-specific T-Lymphocytes
    2. Local inflammatory cellular infiltration of eye
  2. Orbital fibroblasts mediate changes
    1. Adipose hypertrophy
    2. Glycosaminoglycan accumulates
  3. Residual scarring may cause irreversible Proptosis

IV. Risk Factors

  1. Tobacco abuse (Relative Risk 3.7)
  2. Older men appear to have more severe cases
  3. Radioiodine therapy may cause flare in eye disease
    1. Prednisone used to prevent flare
      1. Dose: 40 to 80 mg daily
      2. Taper off over 3 months

V. Symptoms

  1. Ocular pain
    1. Pressure sensation on or behind globe
    2. Worse with Extraocular Movement
  2. Photophobia
  3. Chemosis
  4. Excessive Lacrimation
  5. Diplopia
  6. Proptosis (Exophthalmos)
  7. Eye irritation (gritty sensation, Eye Foreign Body sensation)

VI. Signs

  1. Proptosis (Exophthalmos)
  2. Eyelid and Conjunctiva edema and redness

VII. Radiology

  1. MRI or CT of orbits

VIII. Management

  1. Manage Grave's Disease
  2. Refer all cases to ophthalmology
  3. Treatment used by ophthalmology in mod. to severe cases
    1. High dose Corticosteroids
    2. Orbital decompression

IX. Course

  1. Clinical findings may persist after Thyroid treated

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