Exophthalmos

2. PROPTOSIS
Forward displacement
of the eyeball beyond
the line joining the
superior and inferior
orbital margin.
EXOPHTHALMOS
It is the same thing. But
it is reserved for Thyroid
eye disease.

5.  Thyroid eye disease (TED) :
-lid retraction
-lid lag
-proptosis
Endocrine exophthalmos, Malignant
exophthalmos , Dysthroid
ophthalmopathy, Occular Graves’s
disease (OGD), Graves ophthalmopathy
(GO).

6.  Hyperthyroidism (90%)
 Hypothyroidism (4%)
 Euthyroidism (6%)

7.  Female (4-6 times)
 Smoking
 Middle age
 Autoimmune thyroid ds.
 HLA-DR3, HLA-B8

10.  1. American thyroid association (ATA)

12.  45/F
 Recurrent grave thyrotoxicosis
 Smoker
 TSH 0.03 mu/L , FT4=34 pmol/L
 Red eye, excessive sweating , squint and
double vision.

14. 1. Lid signs
- Dalrymple sign (retraction of upper lids
giving staring and frightened apperance)
- mc and earliest feature

15.  Von Graefe’s sign ( when eye globe is
moved downward, the upper lid lags
behind)

16.  Enroth’s sign (fullnes of eye due to
edema)

17.  Gifford’s sign (difficulty in eversion of
upper lid)

18.  Stellwag’s sign (infrequent blinking)

19.  Jellinek’s sign ( increase pigmentation of
the lids)

20. 2. Conjuctival signs
deep injection
chemosis
3. Pupillary signs
ineqquality of dilatation of pupils

21. 1. Congestive
or active
phase
2. Fibrotic or
inactive phase

24.  Orbital cellulitis
 Idiopathic orbital inflammatory disease
 Sarcoidosis
 Amyloid

26.  Thyroid function test
 Thyroid autoantibody assay
 Usg
 Ct scan
 MRI

29. a) Periodic clinical work up
b) Non-surgical
c) Surgical

31.  Smoking cessation
 Head elevation (night) and cold
compression (morning)
 Artificial tear
 Eyelid taping
 Guanethidine 5% eye drop
 Systemic steroid
 Radiotherapy
 Combined therapy

32.  During active phase orbital
decompression
 During inactive phase extraoccular and eyelid
Sx.

33. Two wall Three wall Four wall
1.)Orbital
floor
2) Medial
wall
Add
roof(lat.
Half) and
sphenoid
at apex.
Add
Lateral
wall

35.  Recession surgery is done
 Mc= inferior rectus recession

36.  Mullerectomy-
 Levator recession-
 Scleral graft with LPS-
 Blepharoplasty-