Introduction: Graves orbitopathy (GO) is an autoimmune disease affecting the orbits and the periorbital tissues with an annual incidence of 16 per 100,000 population in women and 2.9 in men. While GO occurs in the spectrum of hyperthyroidism or Graves disease, 7.9% of these patients have a normal thyroid function and only a few are negative for thyroid antibodies. When left untreated, GO may become debilitating and threaten vision. Case Description: A 64-year-old male presented with gross bilateral proptosis and chemosis, which developed over a period of 10 years. Palpitations, hand tremors, heat intolerance, weight loss, and insomnia were notably absent, and the thyroid gland was normal. The bilateral proptosis was left unattended for 10 years until extreme lagophthalmos and chemosis with corneal and mucosal exposure leading to dryness, foreign body sensation, excruciating eye pain, and blurred vision resulted. Thyroid-stimulating hormone (TSH), T3, and T4, were normal. TSH-receptor antibody (TRAb) and thyroid peroxidase antibody were negative. The computed tomography scan with contrast of the orbits showed bilateral proptosis and extraocular muscle enlargement typical for thyroid eye disease. The patient was diagnosed with TRAb- negative euthyroid GO with a European Group on Graves’ Orbitopathy (EUGOGO) clinical score of 7/7, indicating a severe, active disease. Screening prior to administration of GO immunosuppressive therapy revealed chronic hepatitis B infection. The patient was started with tenofovir for 2 weeks before treatment for GO. The patient was given intravenous methylprednisolone with cumulative dose of 4.5 g for 12 weeks, with daily mycophenolate sodium 0.72 g for 12 weeks. Upon completing the 12-week treatment regimen and undergoing an adjunctive lateral canthotomy and partial tarsorrhaphy, the GO signs and symptoms dramatically resolved, and visual acuity markedly improved. Conclusion This case report presents an unusual condition of a euthyroid, TRAb-negative Graves orbitopathy. It provides insights on the diagnosis and treatment of patients with such atypical presentation. Despite the chronicity and severity of this patient’s GO, excellent results were achieved with appropriate and guideline-directed treatment.
Human ; Male ; Middle Aged: 45-64 Yrs Old ; Graves Ophthalmopathy ; Exophthalmos ; Mycophenolic Acid

Objective: To review the clinical characteristics, to illustrate diagnosis and management experience of orbital and cranial complications of pediatric acute rhinosinusitis. Methods: The clinical data of 24 children with orbital and cranial complications of acute rhinosinusitis who received endoscopic sinus surgery combined with drug treatment in Beijing Children's Hospital from January 2017 to December 2021 were retrospectively reviewed. There were 19 boys and 5 girls. The age varied from 13 to 159 months, with a median 47.5 months. The following diagnoses were obtained: 12 isolated subperiosteal orbital abscess, 2 associated with preseptal abscess, 2 associated with intraorbital abscess, 7 associated with optic neuritis, and 1 associated with septic cavernous sinus thrombosis. Clinical characteristics, organism isolated and outcomes were analyzed through descriptive methods. Results: All 24 patients presented with fever; 9 presented with nasal congestion and purulent discharge. The clinical manifestations of orbital infection included orbital edema, pain, proptosis and displacement of globe in all patients, while visual impairment was recognized in 7 children. Purulent drainage was cultured in 17 patients, among which 12 were positive. All patients underwent nasal endoscopic surgical interventions uneventfully, excluding one patient who required a second surgical procedure. Follow-up period ranged from 5 to 64 months. All patients resolved fully, with the exception of 2 children who got permanent blindness with visual loss preoperative. There was no recurrence or death. Conclusions: Orbital and cranial complications of pediatric acute rhinosinusitis could be severe with an occult onset. For patients with vison impairment, any signs of intracranial complications and a lack of response to conservative management, an urgent endoscopic intervention is needed.
Male ; Female ; Child ; Humans ; Abscess/therapy* ; Retrospective Studies ; Sinusitis/therapy* ; Orbital Cellulitis ; Acute Disease ; Exophthalmos ; Orbital Diseases/therapy*

ABSTRACT Kimura disease (KD) is a rare chronic inflammatory disorder of unknown aetiology that primarily affects the head and neck region with lymph node involvement. Young to middle-aged adult Asian males are predominantly affected. The most common presentation is painless subcutaneous swelling in the head and neck region, while proptosis or orbital involvement is very rarely reported. KD shares some features with other inflammatory and neoplastic disorders, including lymphoma; thus, investigations to confirm the diagnosis should not be delayed. Systemic corticosteroids are commonly used to treat KD and show an excellent response; however, the optimal treatment is still uncertain, and KD has a high recurrence rate. We describe the case of a patient with KD who presented with proptosis and post-auricular swelling, which responded well to oral prednisolone treatment.
Kimura Disease ; Exophthalmos

To explore the clinical acupoint selection rules for hyperthyroidism and related exophthalmos treated with acupuncture. By taking "hyperthyroidism" "acupuncture and moxibustion" as keywords，literature regarding acupuncture for hyperthyroidism and related exophthalmos published was collected in the Chinese Journal Full-text Database (CNKI), VIP Database (VIP) and WANFANG database. The literature was organized, the database of acupuncture prescription was established and the characteristics and rules of acupoint selection were analyzed. A total of 46 papers were included, involving 89 acupoints, the frequency of acupoint application was 449 times. The most commonly used 6 acupoints for hyperthyroidism treated with acupuncture were Sanyinjiao (SP 6), Neiguan (PC 6), Zusanli (ST 36), Shuitu (ST 10), Hegu (LI 4), Taichong (LR 3). And the most meridians of acupoints were the stomach meridian and the pericardium meridian. The most commonly used 6 acupoints for hyperthyroidism related exophthalmos treated with acupuncture were Fengchi (GB 20), Shangtianzhu (Extra), Hegu (LI 4), Sanyinjiao (SP 6), Cuanzhu (BL 2), Yangbai (GB 14). And the most meridian of acupoints was the gallbladder meridian. The most commonly used specific acupoints for hyperthyroidism treated with acupuncture were crossing points, -source points and five- points. The most commonly used specific acupoints for hyperthyroidism related exophthalmos treated with acupuncture were crossing points, -source points and five- points. Acupuncture masters in modern times have achieved significant therapeutic effect in the treatment of hyperthyroidism，which has showed the principles of searching for the primary cause of disease in treatment and giving consideration to both the root cause and symptoms. But there is a lack of simple and effective treatment methods that can be rapidly promoted in clinical practice.
Acupuncture Points ; Acupuncture Therapy ; Exophthalmos ; therapy ; Humans ; Hyperthyroidism ; therapy ; Meridians

Graves' ophthalmopathy (GO) is an autoimmune disease associated with orbital inflammation and fibrosis which can result in lid retraction, soft tissue swelling, and proptosis. Treatment should rely on a thorough assessment of the activity and severity of GO. Control of risk factors for GO progression and topical treatments for dry eye are recommended for all patients. In mild GO, a careful observation is usually sufficient. In moderate-to-severe and active GO, high-dose intravenous glucocorticoids can be considered an initial treatment. The most common schedule for intravenous glucocorticoids is a cumulative dose of 4.5 g of methylprednisolone, divided into 12 weekly infusions (6 weekly infusions of 0.5 g, followed by 6 weekly infusions of 0.25 g). Orbital radiation has been shown to be an effective secondary treatment in patients with active GO unresponsive to intravenous glucocorticoids. Rehabilitative surgery is needed in patients with GO when the disease is associated with a significant impact on quality of life or visual function after the disease has been inactive for at least 6 months.
Appointments and Schedules ; Autoimmune Diseases ; Exophthalmos ; Fibrosis ; Glucocorticoids ; Humans ; Inflammation ; Methylprednisolone ; Orbit ; Quality of Life ; Risk Factors

PURPOSE: We sought to investigate the effects of Graves' orbitopathy (GO) and orbital decompression on lamina cribrosa depth (LCD) using spectral-domain optical coherence tomography. METHODS: Forty eyes that underwent orbital decompression to relieve compressive optic neuropathy or correct disfiguring exophthalmos in the context of GO were included. Subjects were imaged with spectral-domain optical coherence tomography before surgery and at 1 and 3 months after surgery, at which the examiner measured the LCD (distance from the anterior surface of the lamina cribrosa to the Bruch membrane opening line) and peripapillary retinal nerve fiber layer thickness. Subjects were divided into two groups—a muscle-dominant group composed of patients who had extraocular muscle enlargement on preoperative orbital computed tomography scan and a fat-dominant group composed of patients who did not show extraocular muscle enlargement on preoperative orbital computed tomography scan—and subgroup analysis was performed. Preoperative and postoperative intraocular pressure, exophthalmos, LCD, and retinal nerve fiber layer thickness were evaluated. RESULTS: At baseline, LCD was remarkably shallower in the muscle-dominant group than in the fat-dominant group (95% confidence interval, p = 0.007). In the muscle-dominant group, LCD showed no definite change after surgery. However, the fat-dominant group showed temporary posterior displacement of the lamina cribrosa at 1-month postoperation that was reversed to baseline at 3 months postoperation (95% confidence interval, p < 0.01). CONCLUSIONS: The lamina cribrosa was anteriorly displaced preoperatively, and its position was nearly unchanged after the surgery, especially in association with extraocular muscle enlargement. An enlarged extraocular muscle could reduce the pressure-relieving effect of orbital decompression around the scleral canal in patients with GO.
Bruch Membrane ; Decompression ; Exophthalmos ; Graves Ophthalmopathy ; Humans ; Intraocular Pressure ; Nerve Fibers ; Optic Nerve ; Optic Nerve Diseases ; Orbit ; Retinaldehyde ; Tomography, Optical Coherence

Thyroid ophthalmopathy is an autoimmune disease that affect the orbital and periorbital soft tissue, characterized by bulging eye (exophthalmos) and compressed orbital structures, such as the optic nerves. The indications for surgical treatment for thyroid ophthalmopathy include decreased visual acuity caused by optic neuropathy, conjunctivitis and progressive facial deformity caused by exophthalmos. Orbital wall decompression by nasal endoscopy resulte in good cosmetic effects and visual recovery. Balanced orbital decompression is considered to be a safe and effective surgery that can help avoid postoperative diplopia. We introduce three successful cases of orbital wall decompression for the treatment of thyroid ophthalmopathy.
Autoimmune Diseases ; Congenital Abnormalities ; Conjunctivitis ; Decompression ; Diplopia ; Endoscopy ; Exophthalmos ; Optic Nerve ; Optic Nerve Diseases ; Orbit ; Thyroid Gland ; Visual Acuity

The aim of the study is to evaluate the hemodynamic changes and the parenchymal perfusion associated with carotid cavernous fistulas before and after embolization using two-dimensional (2D) parenchymal blood flow analysis. A 15-year-old boy presented with 2-month history of progressive right eye proptosis, chemosis, and diplopia after a motor vehicle accident. Intracranial liquid embolization using Onyx-18 through the inferior petrosal approach was done with balloon protection at the opening of the fistula in the internal carotid artery, resulting in complete occlusion of the fistula. Parenchymal blood flow analysis was done before and immediately after embolization. 2D parametric parenchymal blood flow analysis is newly introduced software that can provide data cannot be conveyed by conventional digital subtraction angiography alone. The software allows for objective assessment of the arterial steal and the parenchymal perfusion both pre, and post-embolization. Pre-embolization assessment may influence the therapeutic decision, while post-embolization assessment can evaluate the treatment efficacy.
Adolescent ; Angiography, Digital Subtraction ; Carotid Artery, Internal ; Diplopia ; Embolization, Therapeutic ; Exophthalmos ; Fistula ; Hemodynamics ; Humans ; Male ; Motor Vehicles ; Perfusion ; Treatment Outcome

Blepharoplasty is one of the most popular cosmetic surgical procedures for people who are concerned with minimizing the effects of aging and maintaining an aesthetically attractive appearance. If periorbital surgery is not performed by an expert, the risk of complications increases. In particular, retrobulbar hematoma, which is the most serious complication after blepharoplasty, can lead to permanent blindness. We report a rare case of unilateral permanent blindness due to careless and unprofessional treatment following a retrobulbar hematoma after lower blepharoplasty. In conclusion, it is necessary to check for symptoms and signs including pain, proptosis, visual acuity, and light reflex after the operation. Careful instructions should then be given to patients and their caregivers to avoid actions that may cause postoperative bleeding. We emphasize that if a patient complains of symptoms, painkillers should not be used and computed tomography should be performed for an accurate and rapid diagnosis. Appropriate procedures must then be taken to prevent permanent vision loss.
Aging ; Blepharoplasty ; Blindness ; Caregivers ; Diagnosis ; Exophthalmos ; Hematoma ; Hemorrhage ; Humans ; Reflex ; Retrobulbar Hemorrhage ; Visual Acuity

Orbital tuberculosis is a rare form of extrapulmonary tuberculosis, even in endemic areas. It may involve the soft tissue, lacrimal gland, periosteum, or bones of the orbital wall. We present a case of orbital tuberculosis on the lower eyelid. An 18-year-old woman with no underlying disease visited our clinic for evaluation of an oval nodule (1.5× 1.2 cm) on the right lower eyelid. Incision and drainage without biopsy was performed 2 months ago in ophthalmology department, but the periorbital mass had deteriorated, as the patient had erythematous swelling, tenderness, and cervical lymphadenopathy. Visual acuity was normal; there were no signs of proptosis, diplopia, or ophthalmoplegia. Computed tomography revealed a small abscess cavity without bony involvement. We performed an excision and biopsy through a percutaneous incision under local anesthesia. Histological examination revealed a granuloma and was diagnosed as orbital tuberculosis. The patient was additionally treated with anti-tuberculosis therapy for 6 months and recovered without complication or recurrence by 7 months. Orbital tuberculosis occurs in patients with or without associated pulmonary tuberculosis, and should be considered as a differential diagnosis in patients with inflammatory orbital disease and an orbital mass. If recurrence occurs despite adequate initial treatment, we recommend an additional examination and excisional biopsy.
Abscess ; Adolescent ; Anesthesia, Local ; Biopsy ; Diagnosis, Differential ; Diplopia ; Drainage ; Exophthalmos ; Eyelids ; Female ; Granuloma ; Humans ; Lacrimal Apparatus ; Lymphatic Diseases ; Ophthalmology ; Ophthalmoplegia ; Orbit ; Orbital Diseases ; Periosteum ; Recurrence ; Tuberculosis ; Tuberculosis, Pulmonary ; Visual Acuity