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Graves Ophthalmopathy
This document summarizes Grave's ophthalmopathy, an autoimmune disorder causing inflammation of the muscles and fatty tissues around the eyes. It begins with an introduction to the disease. It then discusses the different immune defects involved in ophthalmopathy compared to Graves' disease. Epidemiological studies from 1996 in white Americans are presented, showing women are affected 6 times more often than men. The document goes on to discuss the anatomy and physiology of the thyroid gland and orbit, pathogenesis, clinical manifestations, diagnostic examinations including physical exams, lab tests, CT scans and MRI, classifications of diagnosis, and treatments.
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Graves Ophthalmopathy
- 1. GRAVE’S OPHTHALMOPATHY DIAGNOSIS DANPENATALAKSANAANNYA Disusun oleh : Dr. Satya Hutama Pragnanda Pembimbing : Dr. A. Kentar Arimadyo, Sp.M September 19, 2013
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- 3. DEFEK RESPON IMUNBERBEDA pada oftalmopati otot ekstra orbital & kelenjar lakrimal pada penyakit Graves sel-sel folikel tiroid September 19, 2013
- 4. Studi Epidemiologi PadaKulit Putih Amerika Tahun 1996 Insidensi per 100.000 populasi per tahun wanita pria 3 16 TED mempengaruhi wanita 6x lebih sering dari pria (86% vs 14%). Umur median saat didiagnosis TED adalah 43 tahun. Perokok tujuh kali lebih beresiko TED. September 19, 2013
- 5. PEMBAHASAN GRAVES OPHTHALMOPATHY • Kelenjartiroid • Cavum orbita Anatomi & Fisiologi •Inflamasi otot extraocular •Infiltrasi sel radang Patogenesis • Manifestasi Klinis • Pemeriksaan Fisik • Pemeriksaan Penunjang • Diagnosis Banding Diagnosis •Medikamentosa •Radioterapi •Surgical decompression Tatalaksana September 19, 2013
- 6. ANATOMI & FISIOLOGI KELENJARTIROID Glandula Thyroid September 19, 2013
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- 14. MANIFESTASI KLINIS PADAMATA • Soft Tissue Involvement • Lid retraction Disebabkan oleh : Fibrotic contractur Overaksi sekunder superior rectus complex Overaksi M.Muller Tanda : Normalnya upper 2mm dari limbus, lid retraction bila ada scleral show. Dalrymple sign Kocher sign Von Graefe sign • Proptosis • Neuropati optik • Miopati restriktif September 19, 2013
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- 17. PEMERIKSAAN PENUNJANG Laboratorium CTScan MRI USG Orbita September 19, 2013
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- 19. CT SCAN Potongan axial menunjukkanpembesaran badan otot extraocular tanpa keterlibatan tendo otot Potongan coronal menunjukkan pembesaran otot extraocular didalam orbita Potongan sagital menunjukkan penambahan lemak intraconal serta pembesaran ringan otot extraoculer September 19, 2013
- 20. MRI MRI Corona menunjukkan penjepitan(crowding) N.Opticus akibat pembesaran Otot Ekstraoculer MRI Coronal menunjukkan pembesaran M.Rectus Inferior kanan MRI Axial menunjukkan pembesaran M.rectus Inferior MRI axial menunjukkan pembesaran massa otot September 19, 2013
- 21. USG ORBITA USG B-Scanmenunjukkan pembesaran M.Rectus Medial serta visualisasi insersi tendo USG A-scan yang menunjukkan refleksi sedang sampai tinggi dari otot ekstra ocular September 19, 2013
- 22. KLASIFIKASI DIAGNOSIS Riwayat pengobatandisfungsi Tiroid Tanda Orbita Tipikal Bukti radiografis The Mourits Classification System to Access Disease Activity in Graves Ophthalmopathy NOSPECS American Thyroid Association (ATA) PAIN REDNESS SWELLING IMPAIRED FUNCTION Diagnosis Graves Ophthalmopathy ditegakkan apabila memenuhi 2 dari 3 tanda September 19, 2013
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- 24. • Detailed classificationof eye changes of Graves Disease (Modified 1977) • 0 No physical signs or symptoms I Only Signs II Soft-tissue involvement with symptoms and signs o Absent a Minimal b Moderate c Marked III Proptosis ≥ 3 mm in excess of upper normal limit, with/without symptoms o Absent a 3-4 mm increase over upper normal b 5-7 mm increase c 8 or more mm increase IV Extraocular muscle involvement,usually with diplopia,other symptoms/sign o Absent a Limitation of motion, at extreme gaze b Evident restriction of motion c Fixation of globe or globes V Corneal involvement (primarity due to lagophthlmos) o Absent a Stippling or cornea b Ulceration c Clouding, necrosis, perforation VI Sight lost caused by optic nerve involvement o Absent a Disc pallor or choking, or visual field defect acuity 20/20 to 20/60 b Same, acuity 20/70 to 20/200 c Blindness (failure to perceive light), acuity less than 20/200 September 19, 2013
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