Objective: This study determined the prevalence of Graves ophthalmopathy among thyroid-disease patients at a tertiary government hospital. Methods: Patients with thyroid disease seen at a tertiary hospital from February to September 2007 were enrolled. All patients underwent ophthalmologic examination consisting of visual-acuity testing; exophthalmometry; examination for presence of lid retraction, lid lag, and lateral flare; globe position; external-ocular-muscle-movement grading; corneal light reflex; and direct funduscopic examination. All clinical findings were recorded and data were analyzed. Chi square and Fisher’s exact tests determined the association of gender and age to the different ocular signs and symptoms. One-way analysis of variance (ANOVA) compared the average number of ocular symptoms among the different age groups. Results: A total of 121 patients, 20 males and 101 females, with thyroid disease were evaluated. 47.93% had Graves ophthalmopathy, occurring more frequently among patients aged between 30 and 49 years. The most common signs were eyelid retraction, proptosis, and lid lag. Conclusion Graves ophthalmopathy occurs frequently among patients with thyroid disease, especially those more than 30 years of age.
Graves Ophthalmopathy ; Graves Disease ; Exophthalmos ; Thyroid Diseases

PURPOSE: To evaluate the usefulness of exophthalmos measurement on upgaze in patients who are not able to expose corneal vertex on primary gaze. METHODS: The present study included 39 patients with blow out fracture, pseudotumor, or thyroid associated ophthalmopathy and 21 people who don't have any ocular disease. In total, 60 people had exophthalmometry using Hertel exophthalmometer on the basis of corneal vertex, inferior limbus, and inferior sclera by three examiners. RESULTS: The relative exophthalmometry in normal group was 0.71 +/- 0.75 mm, 0.67 +/- 0.62 mm, and 0.69 +/- 0.60 mm on the basis of corneal vertex, inferior limbus, and inferior sclera, respectively. The relative exophthalmometry in exophthalmic group was 1.10 +/- 0.99 mm, 1.13 +/- 0.99 mm, 1.10 +/- 0.91 mm on the basis of corneal vertex, inferior limbus, and inferior sclera, respectively. The relative exophthalmometry in enophthalmic group was 0.79 +/- 0.90 mm, 0.74 +/- 0.92 mm, 0.74 +/- 0.87 mm on the basis of corneal vertex, inferior limbus, and inferior sclera, respectively. There was no statistically significant difference between different measuring points (p > 0.05). The inter-examiner reproducibility was shown to be highly reliable. CONCLUSIONS: The upgaze exophthalmometry on the basis of inferior limbus or inferior sclera would be useful in the patients who are not able to expose corneal vertex on primary gaze.
Exophthalmos ; Graves Ophthalmopathy ; Humans ; Sclera

Graves' disease (GD) can lead to specific eye afflictions including proptosis, periorbital swelling, conjunctival injection, chemosis, and opthalmoplegia, which then become a condition called Graves' ophthalmopathy or thyroid-associated ophthalmopathy (TAO). A carotid cavernous fistula (CCF) is an abnormal vascular communication between the carotid artery and the cavernous sinus. The clinical signs of CCF are very similar to TAO and should be considered as a differential diagnosis of TAO. We would like to present an interesting case of a bilateral ophthalmopathy induced by CCF in a GD patient. A 54-year-old man with a 6-year history of GD presented with bilateral exophthalmos and conjunctival injection for two months. The orbital CT scan findings were consistent with CCF, and an angiography revealed bilateral CCF. He received a bilateral coil embolization for the CCF and his ophthalmic signs were immediately improved. We recommend orbital imaging to exclude other coexisting diseases in patients who are suspected of TAO, especially when the diagnosis is uncertain or when determining whether medical or surgical intervention is appropriate.
Angiography ; Carotid Arteries ; Cavernous Sinus ; Caves ; Diagnosis, Differential ; Exophthalmos ; Eye ; Fistula ; Graves Disease ; Graves Ophthalmopathy ; Humans ; Middle Aged ; Orbit ; Troleandomycin

BACKGROUND AND OBJECTIVES: Little has been known for factors predicting improvement of proptosis in patients with thyroid-associated ophthalmopathy (TAO) after intravenous (IV) glucocorticoid therapy. This study aimed to evaluate the efficacy of IV glucocorticoid therapy and to find factor predicting treatment outcomes in patients with TAO. MATERIALS AND METHODS: Forty-two consecutive patients with TAO treated by IV glucocorticoid from 2000 to 2009 were retrospectively analyzed. They received IV methylprednisolone of 7.0 g over 18 weeks. Before and after treatment, patients underwent orbital CT for assessment of proptosis and extraocular muscle hypertrophy, and physical examination for clinical activity score (CAS). RESULTS: Thirteen patients (31%) showed improvement in proptosis after therapy. High extraocular muscle diameter index was an independent predictor for improvement in proptosis (odds ratio=1.25, p=0.03). Smoking, age, gender and initial CAS did not predict improvement. Seven of 16 patients with initial CAS<3 (43%) and 13 of 17 with initial CAS> or =3 (77%) showed improvement in diplopia after treatment (p=0.002). Of patients with CAS> or =3, patients with intermittent, inconstant and constant diplopia showed improvement in diplopia in 100%, 80% and 63%, respectively. Of patients with CAS<3, patients showed improvement in 80%, 33% and 20%, respectively. CONCLUSION: Presence of extraocular muscle hypertrophy was the only factor predicting improvement in proptosis after IV glucocorticoid therapy. In patients with TAO, IV glucocorticoid therapy could be considered to improve proptosis when they present with increased extraocular muscle diameter, or to improve diplopia especially when they also have high initial CAS.
Diplopia ; Exophthalmos ; Graves Disease ; Graves Ophthalmopathy ; Humans ; Hypertrophy ; Methylprednisolone ; Muscles ; Orbit ; Physical Examination ; Retrospective Studies ; Smoke ; Smoking ; Troleandomycin

In discussing the ocular changes in exophthalmos, the resistance of orbital tissue to the backward displacement of the globe is one of the most interesting things. With the introduction of Copper's orbitonometer, many authors utilized it in case of exophthalmos-producing disease such as Graves' disease, inflammatory conditions of orbit, pseudotumor and neoplasms. The resistance to retrodisplacement of the globe in normal and Graves' disease was measured and the data was analysed in this paper. The orbitonometry with 50 gr., 100 gr. and 200 gr. weight was performed in 40 normal subjects and in 54 cases of thyroid dysfunction. The degree of the displacement of the eyeball were tabulated in table 2. This result shows that severe degree of exophthalmos and ocular findings are always associated with higher orbital tensions.
Exophthalmos ; Graves Disease* ; Orbit ; Thyroid Gland

PURPOSE: To report a case of ocular myasthenia gravis in conjunction with thyroid-associated ophthalmopathy in a patient who showed incomitant strabismus and blepharoptosis as well as to discuss the clinical features and tests that may help distinguish these 2 diseases. CASE SUMMARY: A 46-year-old man without any previous history of systemic and ophthalmic disease presented with binocular diplopia that occured a month earlier. The patient had no other systemic symptoms except a 7 kg weight loss within the last month. The patient was referred to the department of internal medicine and brain magnetic resonance imaging was performed to ascertain the cause of suspected left superior oblique muscle palsy. The patient was diagnosed with Graves' disease and underwent medical treatment. One month later, the patient presented with consistent diplopia and exophthalmos and showed a swelling of eyelid and ptosis in the right eye. Intravenous high-dose steroid therapy was administered to the patient. After the treatment, symptoms of diplopia and lid swelling were improved, however ptosis persisted. Ocular myasthenia gravis was suspected and various tests were conducted. Anti-acetylcholine receptor antibodies were detected in large amounts and ptosis was improved dramatically by an administration of an anticholinesterase agent. The patient was diagnosed with ocular myasthenia gravis in conjunction with thyroid-associated ophthalmopathy. CONCLUSIONS: Ocular myasthenia gravis should be suspected in patients with thyroid-associated ophthalmopathy who have signs or symptoms of ptosis.
Antibodies ; Blepharoptosis ; Brain ; Diplopia ; Exophthalmos ; Eye ; Eyelids ; Graves Disease ; Graves Ophthalmopathy ; Humans ; Internal Medicine ; Magnetic Resonance Imaging ; Middle Aged ; Muscles ; Myasthenia Gravis ; Paralysis ; Polyenes ; Strabismus ; Telescopes ; Weight Loss

Graves' disease is an autoimmune disorder of the thyroid gland and the most common cause of hyperthyroidism. Classic clinical findings include ophthalmopathy (exophthalmos), dermopathy (pretibial myxedema) and thyroid acropachy. The triad of Graves' clinical findings occurs in less than 1% of Graves' patients. We present a case of Graves' disease with the clinical triad of exophthalmos, pretibial myxedema, and thyroid acropachy.
Exophthalmos ; Graves Disease ; Humans ; Hyperthyroidism ; Myxedema ; Thyroid Gland

BACKGROUND AND OBJECTIVES: Dysthyroid ophthalmopathy is consider to be an autoimmune disorder and the disease is permanent in about 70% of the patients. Endoscopic intranasal approach for the decompression has been described by Kennedy in 1990. However a limitation of the approach is that decompression of the orbital floor lateral to the infraorbital nerve is not possible. So we modified caldwell- Luc's approach combined intranasal decompression by endoscopy. MATERIALS AND METHODS: We performed the orbital decompressions in 5 cases with the exophthalmos. When the inferior bony wall was removed, medial and lateral to the inferior orbital nerve were removed separately and bony ridge was created to protect the nerve. Upper one-third of the lateral wall was penetrated to make an space for herniation of orbital content in case of severe exphthalmos. RESULT: All of the cases were satisfied with the surgery and there has been no evidence of the recurrence so far. CONCLUSION: These combined techniques produce satisfactory results, especially in severe cases.
Decompression* ; Endoscopy ; Exophthalmos ; Graves Ophthalmopathy* ; Humans ; Orbit* ; Recurrence

No abstract available.
Exophthalmos* ; Neurofibromatoses*

Meningioma en plaque are extremely rare, not only dose it form a thin layer on the inside of the dura but also infiltrates it an invades the adjacent bone. Painless, slowly developing exophthalmos with palpable swelling in the ipsilateral temporal region, and later impairment of vision and ocular motility indicate menigioma "en plaque" in the temporal region. The authors report a case of meningioma "en plaque" arisen from the outer third of sphenoid ridge.
Exophthalmos ; Meningioma*