Hyperthyroidism and hypothyroidism can both cause eye problems. Hyperthyroidism is associated with thyroid eye disease which can include upper eyelid retraction, optic disc edema, and conjunctivitis. Hypothyroidism symptoms include eyelid fasciculation, cataracts, and optic disc edema. Thyroid eye disease is thought to be an autoimmune condition where orbital fibroblasts are the primary target of inflammation. Clinical features include eyelid swelling, proptosis, diplopia, and optic neuropathy. Management involves monitoring, nonsurgical options like steroids, and possible surgical decompression or muscle surgery.

1. G.Sameer krishna

2. HYPER THYROIDISM –
_ THYROID OPTHALMOPATHY
 SUPERIOR LIMBIC KERATOCONJUNCTIVITIS
 OPTIC DISC OEDEMA
 HYPO THYROIDSM-
 FASCICULATION
 CATARACT
 OPTIC DISC OEDEMA

3. -Etiopathogenesis
 Clinical course
 Clinical features
 Classification
 Diagnosis
 Management

4.  ETIOPATHOGENESIS:
 Thyroid eye disease may be assosiated with
hyperthyroidism(90%),hypothyroidsm(4%)and
euthyroidsm(6%).

5.  Female sex-(4 to 6 times ) then males.
 Smoking
 Middle age
 AUTOIMMUNE thyroid disease.
 HLA-DR3 and HLA-B8

6.  PATHOGENESIS:-
 It is considered as auto immune disease with
ORBITAL FIBROBLASTS as the PRIMARY
TARGET of inflammation.
 EXTRAOCULAR MUSCLES being SECONDARILY
involved.
 Activated T-cells probably act on
fibroblast-adipocyte lineage.
 This simulates adipogenesis fibroblast
proliferation and glycosaminoglycan
synthesis.

7.  1.CONGESTIVE PHASE OR ACTIVE PHASE
 2.FIBROTIC OR INACTIVE PHASE

8.  LID SIGNS:
 Retraction of the Upper eye lid
 Lid lag is seen.
 Fullness of eye lids due to puffy oedematous
swelling .
 Difficulty in eversion of upper lid .

9.  2.CONJUCTIVAL SIGNS :
 Chemosis

10.  PUPILARY SIGNS :
Inequality in dilation of pupils

11.  OCCULAR MOTILITY DEFECTS;
 This ranges from convergence weakness
(MOBIUS SIGN) to partial or complete
immoblity of one or all of the muscles.
 MOST COMMON- Unilateral elevator palsy
due involvement of the INFERIOR RECTUS
followed by failure of abduction due to
involvement of MEDIAL RECTUS

12.  EXOPTHALMOS:-
 It is common and classical sign of the
disease.
 Generally eyes are symmetrically affected but
it is frequent to find one eye being more
prominent than other.

13.  EXPOSURE KERATITIS AND SYMPTOMS OF
OCCULAR SURFACE DISCOMFORT:-
 This includes sandy or gritty sensation,
lacrimation and photophobia.

14.  OPTIC NEUROPATHY:
 It occurs in about 60% of cases due to direct
compression of the nerve or its blood supply
by enlarged rectus muscles at the orbital
apex.
 It may manifest as the papilloedema or optic
atrophy with associated slowly progressive
impairment of vision.

15.  STELLWAG”S SIGN-Infrequent blinking
 DARYMPLE”S SIGN –Retraction of upper lid.
 ENROTH”S SIGN-Fullness of eyelids.
 GIFFORD”S SIGN-Difficulty in eversion of
upper lid.
 VON GRAEFE”S SIGN- When eye ball is moved
downward upper lid lags behind.

16.  AMERICAN THYROID ASSOCIATION:-
 They classified graves opthalmopathy
irrespective of the hormonal status into
following from 0 to 6 classes.

18.  CLINICAL DIAGNOSIS:-
 THYROID FUNCTION TEST:-
 TSH ,T3,and T4 estimation of radioactive
iodine uptake.
 THYROID AUTOANTIBODY ASSAY:-
 TSH receptors,anti thyroid
peroxidase,antithyroglobulin ,and thyroid
stimulating antibodies.
 ULTRASONOGRAPHY:-
 Detect change in extraoccular muscles even
in class 0 and 1 thus helps in early
diagnosis.

19.  COMPUTERISED TOMOGRAPHIC SCANNING:-
 It may show proptosis , muscle thickness ,
thickening of optic nerve and anterior
prolapse of orbital septum.
 MRI:-
 Gives better soft tissue resolution and
identifies active disease.

20.  MANAGEMENT:-
 It can be managed by
1. PERIODIC CLINICAL WORK UP
2. NON-SURGICAL MEASURES
3. SURGICAL MEASURES

21. PERIODIC CLINICAL WORK UP:-
It is essential to document the clinical course
of the disease periodically to decide the
treatment required and to monitor the effect
of therapy.
clinical activity score is taken and treament is
given accordingly.

22.  Pain - 1.Retrobulbar pain
 2.pain on ocular movement
 Redness -3.redness of lids
 4.redness of conjunctiva
 Swelling -5. swelling of lids
 6.swelling opf conjunctiva
 7.swelling of caruncle
 8.proptosis
 Loss of - 9.decrease in eye movement(By
function 5degrees over 1-3months.
 10.decrease in vision by 1snellen
 line over 1-3 months

23.  NON SURGICAL MANAGEMENT:-
 Smoking cessation
 Head elevation at night and cold compresses
in the morning help in reducing periorbital
oedema
 Lubricating eye drops during day and
ointment at night.
 Eye lid tapping at night prevents exposure.
 Guanethidine 5% drops may decrease the lid
retraction caused by overaction of muller’s
muscle

24.  Prisms may be prescribed to diplopia till the
quiescent phase is reached.
 Systemic steroids
 Radiotherapy 2000rads given over 10 days is
used when steroids are contraindicated.
 Combined therapy with low dose steroids and
irradiation is reported to be more effective.

25.  SURGICAL MANAGEMENT:-
 It is a step wise procedure involving
 Orbital decompression followed by
extraocular muscle surgery followed by eyelid
surgery

26.  It is usually associated with congenital
cataract
 It occurs due to deficiency of galactose 1
phosphate uridyl transferase(GPUT) and
galactokinase
 Associated with bilateral cataract which may
be reversible and prevented if detected early
if milk and milk products are eliminated.

27.  It is autosomal recessive inborn error of
metabolism.
 It is associated with subluxation of lens
inferiorly or nasally.
 Diagnosis is done by detecting homocysteine
in urine by sodium nitro prusside test.

28. OCULAR LESIONS INCLUDE-
 Corneal opacification
 Pigmentary retinopathy
 Glaucoma and
 Optic atrophy

29. SUNFLOWER
CATARACT