Ted.Dec08
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1) Thyroid eye disease (TED) is an autoimmune disorder associated with Graves' disease. It can affect the eye muscles, fatty tissue, and optic nerve. 2) Treatment depends on the severity and activity of TED. Mild and inactive cases may only require monitoring. Moderate to severe or active cases are treated with intravenous steroids, radiation therapy, or surgery. 3) Sight-threatening TED requires immediate treatment such as steroids or orbital decompression to reduce pressure on the optic nerve. Rehabilitative surgery can help with functional issues from TED.
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Thyroid eye diseases
Thyroid eye disease (TED) is a common orbital disorder caused by an autoimmune reaction. It involves inflammation and swelling of the extraocular muscles and orbital connective tissues. The main clinical manifestations include soft tissue involvement, lid retraction, proptosis, optic neuropathy, and restrictive myopathy. Treatment depends on disease severity and includes lubricants, steroids, radiation therapy, orbital decompression surgery, and in severe cases intravenous steroids to prevent sight loss from optic neuropathy. Surgical intervention may be needed for disfiguring proptosis or restrictive myopathy after the inflammatory phase subsides.
Vogt Koyanagi Harada Disease
1) VKH disease is a multisystem disorder characterized by granulomatous panuveitis with exudative retinal detachments and associated neurologic and cutaneous manifestations.
2) It was first described separately by three doctors (Vogt, Koyanagi, and Harada) in the early 20th century before being recognized as a single disease.
3) It has distinct prodromal, uveitic, chronic, and chronic recurrent stages with characteristic ocular and systemic findings at each stage. International criteria have been developed to classify its complete, incomplete, and probable forms.
Thyroid eye disease presentation
thyroid eye disease is becoming a very common eye disorder with more than 42 million people affected in india with thyroid disease. About 2.9 men and 16 women/lac/year are newly diagnosed with thyoid disease.
Thyroid eye disease
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2) It was first described separately by three doctors (Vogt, Koyanagi, and Harada) in the early 20th century before being recognized as a single disease.
3) It has distinct prodromal, uveitic, chronic, and chronic recurrent stages with characteristic ocular and systemic findings at each stage. International criteria have been developed to classify its complete, incomplete, and probable forms.
Thyroid eye disease presentation
thyroid eye disease is becoming a very common eye disorder with more than 42 million people affected in india with thyroid disease. About 2.9 men and 16 women/lac/year are newly diagnosed with thyoid disease.
Thyroid eye disease
Thyroid eye disease (TED), also known as Graves' ophthalmopathy, is an autoimmune disorder affecting the eyes that is commonly associated with Graves' disease and hyperthyroidism. It causes inflammation and swelling of the muscles and fatty tissues behind the eyes. The document discusses the epidemiology, risk factors, pathogenesis, clinical features including proptosis, lid retraction, optic neuropathy, and restrictive myopathy, as well as treatments such as steroids, radiation, orbital decompression surgery, and eyelid surgery. Management involves treatment of both the eye symptoms and any underlying thyroid abnormalities.
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Peripheral Ulcerative Keratits
Peripheral ulcerative keratitis (PUK) is a destructive inflammatory disease of the peripheral cornea characterized by epithelial defects, stromal thinning and infiltration, and potential perforation. It can be caused by autoimmune, infectious, or inflammatory processes. Treatment involves topical lubricants, antibiotics, corticosteroids, and systemic immunosuppressants depending on severity and underlying etiology to stop corneal melting and promote healing. A thorough workup is needed to identify any associated systemic diseases.
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The document discusses retinal vein occlusion (RVO), specifically central retinal vein occlusion (CRVO), including its demographics, pathogenesis, classification as either ischemic or non-ischemic CRVO, management through examination, investigation and treatment options, and guidelines on systemic evaluation and management. CRVO results from obstruction of venous outflow causing increased pressure and damage to retinal capillaries and is classified based on the location and extent of occlusion, with ischemic CRVO having a poorer visual prognosis without timely treatment.
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This document provides terminology and descriptions related to evaluation of the optic disc. It describes normal anatomy and features of the optic disc including size, shape, color, zones, and vessels. It also summarizes various congenital and acquired optic disc anomalies including glaucoma, papilledema, optic neuropathies, tumors, and other conditions. Key features are described for different stages and types of each condition.
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1) Thyroid eye disease (TED) is an autoimmune disorder associated with Graves' disease. It can affect the eye muscles, fatty tissue, and optic nerve.
2) Treatment depends on the severity and activity of TED. Mild and inactive cases may only require monitoring. Moderate to severe active TED is treated with intravenous steroids, radiation therapy, or surgery. Sight-threatening TED urgently requires treatments like steroids and orbital decompression.
3) Managing thyroid function and advising patients to stop smoking can help prevent progression of TED. Referral to a specialist TED clinic is recommended for persistent or worsening eye symptoms.
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Thyroid eye disease (TED), also known as Graves' orbitopathy, is a self-limiting autoimmune condition that affects the eye muscles and fatty tissues behind the eyes. It is commonly associated with Graves' disease and hyperthyroidism. Treatment depends on the severity and includes corticosteroids to reduce inflammation, radiation therapy, orbital decompression surgery, and eyelid or muscle surgery to correct motility disorders or abnormalities. While TED has no cure currently, treatment aims to manage active inflammation and correct residual issues once the disease becomes inactive.
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This document discusses Thyroid Eye Disease (TED), a common orbital disorder associated with thyroid dysfunction. It covers the epidemiology, pathology, clinical features, evaluation, and management of TED. Some key points:
- TED is an autoimmune condition causing inflammation and swelling of extraocular muscles and orbital tissues. It is seen in Graves' disease and Hashimoto's thyroiditis.
- Symptoms include eye irritation, bulging eyes (proptosis), and impaired eye movement. Signs include eyelid retraction, proptosis, and restrictive extraocular muscle involvement.
- Evaluation involves assessing thyroid function and signs of orbital involvement. Severity is classified using Werner's or EUGO
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Anterior eye structures disorders
This document provides information on various disorders, pathologies, and diseases that can affect the anterior structures of the eye. It discusses conditions such as:
- Disorders of the eyelashes including trichiasis, distichiasis, and madarosis.
- Benign eyelid lesions including chalazions, molluscum contagiosum, and xanthelasma.
- Malignant eyelid tumors such as basal cell carcinoma, squamous cell carcinoma, and melanoma.
- Conjunctival disorders including bacterial and viral conjunctivitis, vernal conjunctivitis, and pterygium.
- Corneal pathologies such as infectious keratitis
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1. Differential diagnosis of disc edema includes conditions like papilledema, optic neuritis, ischemic optic neuropathy, diabetic papillopathy, and hypertensive retinopathy.
2. Papilledema is caused by increased intracranial pressure and presents with bilateral disc swelling and normal vision, while optic neuritis typically causes unilateral vision loss and eye pain.
3. Diabetic papillopathy presents as transient unilateral or bilateral disc edema that resolves within months without vision loss, while malignant hypertension can lead to bilateral disc edema and vision changes as part of hypertensive retinopathy.
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2. The condition can be congenital or acquired, with causes including superior rectus palsy, inferior rectus restriction, and supranuclear lesions.
3. Surgical management of MED depends on forced duction test results and may include inferior rectus recession, superior rectus resection, or Knapp's procedure to transpose the horizontal rectus muscles. The goal is to improve eye position and increase binocular vision.
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This 53-year-old man presented with sudden onset of proptosis in both eyes 5 months ago. He was diagnosed with orbital pseudotumor but showed no improvement with steroids. Thyroid function tests were initially normal but one test showed hyperthyroidism that later normalized. Exophthalmometry showed progression of proptosis. Given his family history of thyroid disease, progressive proptosis, and initial hyperthyroidism, he most likely has Graves' orbitopathy despite atypical presentation and lack of response to steroids. Further workup is needed to confirm the diagnosis and guide management.
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Thyroid Eye Disease
1) Thyroid eye disease (TED) is an autoimmune disorder associated with Graves' disease. It can affect the eye muscles, fatty tissue, and optic nerve.
2) Treatment depends on the severity and activity of TED. Mild and inactive cases may only require monitoring. Moderate to severe active TED is treated with intravenous steroids, radiation therapy, or surgery. Sight-threatening TED urgently requires treatments like steroids and orbital decompression.
3) Managing thyroid function and advising patients to stop smoking can help prevent progression of TED. Referral to a specialist TED clinic is recommended for persistent or worsening eye symptoms.
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THYROID EYE DISEASE
Thyroid eye disease (TED), also known as Graves' orbitopathy, is a self-limiting autoimmune condition that affects the eye muscles and fatty tissues behind the eyes. It is commonly associated with Graves' disease and hyperthyroidism. Treatment depends on the severity and includes corticosteroids to reduce inflammation, radiation therapy, orbital decompression surgery, and eyelid or muscle surgery to correct motility disorders or abnormalities. While TED has no cure currently, treatment aims to manage active inflammation and correct residual issues once the disease becomes inactive.
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The document summarizes key points from a conference on diabetes and insulin. It discusses the various ocular manifestations of diabetes, including retinopathy, neuropathy, glaucoma and cataracts. It notes that up to 95% of those with type 1 diabetes and 60% of those with type 2 diabetes develop retinopathy. Risk factors include blood sugar levels, blood pressure, duration of diabetes, blood lipids, ethnicity and pregnancy. Screening guidelines are provided based on diabetes type and risk level. Imaging techniques like OCT and treatments like anti-VEGF injections plus laser therapy are reviewed. Novel research areas are also highlighted.
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Posner-Schlossman syndrome is characterized by recurrent unilateral attacks of ocular hypertension accompanied by mild anterior chamber inflammation. It was first described in 1948 and affects people aged 20-50, with males and females equally impacted. The exact pathogenesis is unknown but may involve trabecular meshwork obstruction by mononuclear cells. Symptoms include blurred vision and eye discomfort. Signs include elevated IOP out of proportion to mild inflammation and open iridocorneal angles. While usually self-limiting, long-term damage from recurrent attacks can occur, so treatment focuses on IOP control and inflammation management medically or surgically if needed.
Thyroid eye diseases
Thyroid ophthalmopathy (TED) is an autoimmune disorder where antibodies against the TSH receptor cause inflammation and swelling of the extraocular muscles and orbital tissues. The classic signs include eyelid retraction, proptosis, diplopia, and issues with eye movement. The symptoms result from infiltration of lymphocytes, plasma cells and fibrosis of the extraocular muscles leading to enlargement. Risk factors include Graves' disease, smoking, radiation exposure, and other autoimmune disorders. Diagnosis involves evaluating for these clinical signs and ruling out other potential causes of eye swelling.
Brown's syndrome
Brown's syndrome is a condition where there is limited elevation of the eye in adduction due to impaired movement of the superior oblique tendon through the trochlea. It can be congenital or acquired. Congenital cases are usually idiopathic while acquired cases result from damage to the trochlea or tendon, or inflammation. Symptoms include limited elevation in adduction, a positive forced duction test, and occasionally downshoot in adduction or anomalous head posture. Treatment depends on whether the case is congenital or acquired, with congenital cases often not requiring treatment and acquired cases potentially benefiting from steroids and treatment of the underlying cause.
Duane retraction syndrome
This document discusses Duane retraction syndrome, an ocular motility disorder characterized by defective horizontal eye movement and narrowing of the eyelid when the eye adducts. It is usually unilateral and sporadic, though some familial cases are due to mutations in the CHN1 gene. There are four types described based on limitations of adduction and abduction. Duane syndrome can occur with other syndromes and limb abnormalities. Clinical features and differential diagnosis are provided. Surgical treatment depends on the type of strabismus and may include recession or resection of extraocular muscles.
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This document discusses Thyroid Eye Disease (TED), a common orbital disorder associated with thyroid dysfunction. It covers the epidemiology, pathology, clinical features, evaluation, and management of TED. Some key points:
- TED is an autoimmune condition causing inflammation and swelling of extraocular muscles and orbital tissues. It is seen in Graves' disease and Hashimoto's thyroiditis.
- Symptoms include eye irritation, bulging eyes (proptosis), and impaired eye movement. Signs include eyelid retraction, proptosis, and restrictive extraocular muscle involvement.
- Evaluation involves assessing thyroid function and signs of orbital involvement. Severity is classified using Werner's or EUGO
Glaucoma
Glaucoma is a group of eye disorders characterized by optic nerve damage and visual field loss. Primary open-angle glaucoma (POAG) is the most common type of glaucoma. It is caused by a gradual increase in eye pressure due to impaired outflow of fluid from the eye. Risk factors include older age, family history, race, and high eye pressure. Patients may be asymptomatic initially, but can experience vision loss over time without treatment to lower eye pressure and prevent further optic nerve damage. Diagnosis involves examining the optic disc for cupping, visual field testing, and measuring intraocular pressure. Early treatment can help prevent vision loss from POAG.
Malignant Glaucoma
Malignant glaucoma, also known as aqueous misdirection syndrome, is a secondary glaucoma that occurs when aqueous humor takes an abnormal posterior route behind the lens and vitreous instead of flowing normally through the pupil. It presents with a shallow anterior chamber despite high intraocular pressure. Potential causes include prior eye surgery or laser treatment. Diagnosis involves examining for signs of anterior chamber shallowing and ruling out other conditions. Treatment begins with cycloplegic drugs but may require Nd:YAG laser or vitrectomy if unresponsive. Prognosis depends on severity and underlying anatomy.
Anterior eye structures disorders
This document provides information on various disorders, pathologies, and diseases that can affect the anterior structures of the eye. It discusses conditions such as:
- Disorders of the eyelashes including trichiasis, distichiasis, and madarosis.
- Benign eyelid lesions including chalazions, molluscum contagiosum, and xanthelasma.
- Malignant eyelid tumors such as basal cell carcinoma, squamous cell carcinoma, and melanoma.
- Conjunctival disorders including bacterial and viral conjunctivitis, vernal conjunctivitis, and pterygium.
- Corneal pathologies such as infectious keratitis
Differential Diagnosis of Disc Edema
1. Differential diagnosis of disc edema includes conditions like papilledema, optic neuritis, ischemic optic neuropathy, diabetic papillopathy, and hypertensive retinopathy.
2. Papilledema is caused by increased intracranial pressure and presents with bilateral disc swelling and normal vision, while optic neuritis typically causes unilateral vision loss and eye pain.
3. Diabetic papillopathy presents as transient unilateral or bilateral disc edema that resolves within months without vision loss, while malignant hypertension can lead to bilateral disc edema and vision changes as part of hypertensive retinopathy.
Double elevator palsy
1. Monocular elevation deficiency (MED), also known as double elevator palsy, is characterized by an inability to elevate one eye in all fields of gaze, resulting in hypotropia of the affected eye.
2. The condition can be congenital or acquired, with causes including superior rectus palsy, inferior rectus restriction, and supranuclear lesions.
3. Surgical management of MED depends on forced duction test results and may include inferior rectus recession, superior rectus resection, or Knapp's procedure to transpose the horizontal rectus muscles. The goal is to improve eye position and increase binocular vision.
Ophthalmology 5th year, 5th lecture (Dr. Ali)
Ocular trauma can cause injuries to the eyeball and surrounding structures. Common types of injuries include chemical burns, thermal burns, blunt trauma, penetrating injuries, and injuries involving retained foreign bodies. A thorough history and examination are important to classify the injury and determine appropriate treatment. Minor injuries like corneal abrasions are generally treated with antibiotics while more severe injuries involving penetration of the eye wall may require specialty care. Prevention emphasizes reducing risk factors for work, home, sports, and transportation related injuries through primary, secondary and tertiary prevention strategies.
Sudden loss of vision IN A PATIENT ACUTELY
OPTIC NEURITIS RETINAL DETACHMENT OCCIPITAL STROKE VITREOUS HAEMORRHAGE CENTRAL RETINAL ARTERY OCCLUSION CAUSE SUDDEN BLINDNESS
Corneal ectasias
Corneal ectasias are a group of diseases characterized by corneal thinning and changes in shape. The main types are keratoconus, keratoglobus, and pellucid marginal degeneration. Keratoconus causes a cone-shaped protrusion of the cornea typically in the inferior region. It has a variety of signs on exam including Fleischer rings, Vogt's striae, and corneal scarring. Treatment involves contact lenses, intracorneal ring segments, corneal cross-linking, or transplantation. Keratoglobus is a non-progressive ectasia causing generalized thinning. Pellucid marginal degeneration causes a band of thinning separated from the limbus.
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This 53-year-old man presented with sudden onset of proptosis in both eyes 5 months ago. He was diagnosed with orbital pseudotumor but showed no improvement with steroids. Thyroid function tests were initially normal but one test showed hyperthyroidism that later normalized. Exophthalmometry showed progression of proptosis. Given his family history of thyroid disease, progressive proptosis, and initial hyperthyroidism, he most likely has Graves' orbitopathy despite atypical presentation and lack of response to steroids. Further workup is needed to confirm the diagnosis and guide management.
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TED, also known as thyroid eye disease, is an autoimmune disorder caused by antibodies activating orbital fibroblasts. It is characterized by enlargement of the extraocular muscles and fatty tissue. TED occurs in approximately 50% of patients with Graves' disease, an autoimmune disorder of the thyroid gland. Diagnosis involves evaluating symptoms, signs of proptosis and extraocular muscle involvement, and laboratory/imaging tests. Management ranges from conservative measures to steroids, radiation, surgery, and the recently FDA-approved treatment teprotumumab. Complications include optic neuropathy.
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RADIOTHERAPEUTIC TREATMENT
Indications:
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- Inflammatory synovitis
- Postoperative pain relief
- As an adjunct to conservative measures
Technique:
- Low energy X-rays or electrons
- Small field sizes (2-4 cm)
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Results:
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This document summarizes a case presentation of a 40-year-old male with thyroid eye disease. He presented with protrusion of both eyeballs that had worsened over two years along with recent double vision. Examination found lid retraction, congestion, and proptosis in both eyes. The patient had a history of hyperthyroidism treated with medication. Imaging found thickened extraocular muscles and increased orbital fat. He was diagnosed with active thyroid eye disease and underwent orbital decompression surgery on the left eye, with plans for the right eye. His condition improved after surgery and medication. The presentation reviewed the diagnosis and management of thyroid eye disease, including identifying the active stage, treatments, and role of surgery.
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Graves' disease is the most common cause of hyperthyroidism, affecting about 0.4% of the population, predominantly women. It is an autoimmune disorder where antibodies stimulate the thyroid stimulating hormone receptor, causing hyperthyroidism. In addition to hyperthyroidism, Graves' disease can cause ophthalmopathy in 20-40% of cases and dermopathy in 0.5-4.3% of cases. Diagnosis is made through laboratory tests showing suppressed thyroid stimulating hormone and elevated free thyroxine and/or triiodothyronine levels. Treatment options include antithyroid medications, radioactive iodine ablation, or surgery to remove the thyroid gland.
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Optic neuritis.Neuroophthalmology, Teaching Slides, Dr M D Mohire, Kolhapur, ...
This document provides an overview of optic neuritis and optic neuropathies. It discusses various types of optic neuritis including acute demyelinating, multiple sclerosis-related, neuromyelitis optica-related, and ADEM-related optic neuritis. It also covers ischemic optic neuropathies, specifically nonarteritic anterior ischemic neuropathy and arteritic anterior ischemic neuropathy. Additional topics include nutritional, infectious/parainfectious, toxic, and compressive optic neuropathies. Diagnostic approaches and treatments are described for many of these conditions.
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Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
About AOMA: The Academy of Oriental Medicine at Austin offers a masters-level graduate program in acupuncture and Oriental medicine, preparing its students for careers as skilled, professional practitioners. AOMA is known for its internationally recognized faculty, award-winning student clinical internship program, and herbal medicine program. Since its founding in 1993, AOMA has grown rapidly in size and reputation, drawing students from around the nation and faculty from around the world. AOMA also conducts more than 20,000 patient visits annually in its student and professional clinics. AOMA collaborates with Western healthcare institutions including the Seton Family of Hospitals, and gives back to the community through partnerships with nonprofit organizations and by providing free and reduced price treatments to people who cannot afford them. The Academy of Oriental Medicine at Austin is located at 2700 West Anderson Lane. AOMA also serves patients and retail customers at its south Austin location, 4701 West Gate Blvd. For more information see www.aoma.edu or call 512-492-303434.
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Ted.Dec08
- 1. Thyroid Eye Disease Dr Bijay Vaidya Dept of Endocrinology, Royal Devon & Exeter Hospital, Exeter
- 3. Pathogenesis of TED NEJM, 2000
- 4. CT Orbits TED Normal
- 6. How to Assess TED?
- 10. Activity vs. Severity of TED BMJ, 2004
- 13. How to Manage Thyrotoxicosis in a patient with TED?
- 17. TED After Radioiodine in Smokers & Non-smokers Bartalena, Ann Intern Med, 1998 % Progression of TED (n=82) (n=68) 23% 6%
- 19. Radioiodine Treatment in Patients with Inactive TED * * * Perros et al., JCEM 2005
- 21. How to Treat?
- 23. Is TED Related to Smoking? % Hagg & Asplund, BMJ, 1987 83% 46% 31%
- 24. Smoking & Risk of TED Odds Ratio P<0.01 1.9 4.4 EJE, 2002
- 25. Smoking & Response to Treatment Ann Intern Med, 1998
- 28. Efficacy of Oral Steroids in TED %
- 31. Efficacy of IV Steroids in TED %
- 35. Efficacy of Radiotherapy in TED %
- 40. Randomised Controlled Trial of Octreotide-LAR JCEM, 2004 -8 Octreotide Placebo Octreotide Screening 0 16 32 Weeks 56
- 41. Clinical Activity Score placebo LAR *** *** ***p <.001
- 43. Role of Rehabilitative Surgery
- 44. Impact of TED on Quality of Life Thyroid, 1997
- 45. % How does/did your TED affect your quality of life?
- 46. Summary: Management of TED Stop smoking, maintaining euthyroidism & supportive measures All stages IV methylprednisolone decompression Sight-threatening Rehabilitative surgery Moderately severe (inactive) Immuno-suppression and/or radiotherapy Moderately severe (active) ‘ Wait-and-see’ Mild
- 47. Who to Refer to Specialist TED Clinic?
- 51. The UK TED Patient Survey: Attend/Attended Specialist TED Clinic? %
- 52. *p<0.05, ** p<0.01 The UK TED Patients Survey: Specialist TED clinic vs. No Sp TED Clinic % % % % % ** * * *
- 53. Further Reading: Consensus statement of the European group on Graves' orbitopathy (EUGOGO) on management of Graves' orbitopathy. Eur J Endocrinol. 2008 Mar;158(3):273-85.