"Exophthalmos" Presentation Bachelor degree semester 5. 5.31.2015

1. Exophthalmos & thyroid eye
disease
A case report for a ‘Grand Round’
By Parisa Naji
Professor : Dr.Golestani Nasab
28 may 2015

2. Exophthalmia
The Greek word ophthalmos means "eye" and the
Greek word ex means "out".

3. What are the causes of exophthalmos?
• The thyroid gland & Thyroid eye disease
• Autoimmune diseases
• Inherited diseases
• Other factors
. A cancerous tumor
.. Mucocoele (mucus-filled cyst)
... A blood clot
.… Trauma (eye injury)
….. Sinus infection

4. T S H
r e c e p t o r s
o r b it a l
f a t / m u s c le
c e ll
( G r a v e s
d is e a s e )
Receptors
increase with
smoking
Hypothroidism
increases TSH
What is happening in the orbit?

5. T S H
r e c e p t o r s
Cell swells up
with
glcycoproteins
etc

6. What are the signs and symptoms of
exophthalmos?
Symptoms of Graves' disease
•Pain in the eyes
•Dry eyes
•Eye irritation
•Sensitivity to light (photophobia)
•Lacrimation - eye secretions and shedding of tears
•Diplopia - double vision caused by the weakening of the eye muscles
•Progressive blindness, if the optic nerve is compressed
•Difficulty in moving eyes - as the eye muscles weaken the patient may
find it harder to move the eyes. In some cases the eyes may turn inwards
(amblyopia).

7. What are the signs and symptoms of
exophthalmos?
Non-ocular signs and symptoms
•Irregular heartbeats (arrhythmia, palpitations)
•Anxiety
•Raised appetite
•Sleeping problems (insomnia)

8. Appearance
1. Upper lid retraction
2. Lower lid retraction
3. Exophthalmos (proptosis)
4. Dry eyes
5. Soft tissue lid swelling
Symptoms
1. Sore eyes/dry eyes/watery
2. Appearance
3. Optic nerve damage
4. glaucoma

9. Pathology, basis
Enlarged ocular muscles & soft tissues
Glycoproteins accumulate inside cells, lipid
accumulation, lymphocytes, fibrosis
Pushes eye forward… exophthalmos
Or presses on optic nerve (blindness)
Eye movements reduced, squints

10. How is exophthalmos diagnosed?
• A blood test
• Exophthalmometer
• Imaging scans

11. What do we do in eye clinic
Note symptoms/appearance
Measure exophthalmos/TED group

12. What do we do in eye clinic
Note symptoms/appearance
Measure exophthalmos/TED group
Afferent pupillary defect
Test visual fields, colour vision,
eye pressure, examine optic disc

13. What do we do in eye clinic
Note symptoms/appearance
Measure exophthalmos/TED group
Afferent pupillary defect
Test visual fields, colour vision,
eye pressure, examine optic disc
CT scan..diagnosis, especially if
unilateral

14. What do we do in eye clinic?
Note symptoms/appearance
Measure exophthalmos/TED group
Afferent pupillary defect
Test visual fields, colour vision,
eye pressure, examine optic disc
CT scan..diagnosis, especially if
unilateral
Diagnose/treat ‘active’disease
& inactive disease..eg lid/squint
surgery

15. Exophthalmia At Animals

16. Thanks For Your Attention