For medical students

2. THYROID
OPHTHALMOPATHY
LT COL AMER YAQUB
CLASSIFIED EYE SPECIALIST
MBBS, MCPS, FCPS, FRCS (Ed)

3. THYROTOXICOSIS
 Autoimmune Disorder
 Third and fourth decade
 Women more commonly involved

4. Thyroid Orbitopathy
 PATHOGENESIS
 Organ specific autoimmune reaction in IG g
antibody produces following :
 Inflammation of extra ocular muscle
 Inflammatory cellular infiltration

5. CLINICAL MANIFESTATION
 Precede, coincide with or
follow hyperthyroidism
 No relation to the severity
of thyroid dysfunction

6.  STAGES
Congestive
(inflammatory disease)
in which the eyes are
red & painful. Remits
within 3 yrs.
Fibrotic (quiescent)
eye white painless.
Motility defect may
present.

7. SIX MAIN MANIFESTATIONS
1. Soft tissue involvement
2. Lid retraction
3. Proptosis
4. Optic Neuropathy
5. Restrictive myopathy
6. Corneal exposure

8. SOFT TISSUE INVOLVEMENT
Symptoms
 grittiness,
 photophobia,
 lacrimation,
 retro bulbar discomfort.

9. Signs
 periorbital and lid
swelling
 conjunctival and
episcleral hyperemia
 chemosis
 superior limbic
keratoconjunctivitis

10. MANAGEMENT
 Topical lubricant
 Head elevation
 Taping of eyelid

11. LID RETRACTION
 PATHOGENESIS
Fibrotic contracture of levator
Secondary over action of levator superior rectus
complex
Humorally induced overaction of Muller muscle
 SIGNS
Lid retraction
Dalrymple sign
Von Graefe sign
Kocher sign

13. MANAGEMENT
 Mild ___ Not required
 Significant but stable retraction __ Surgery
 Sequence of surgery
 Orbit
 Strabismus
 Eyelid
 Surgical Procedures
 IR recession
 Mullerotomy
 Recession of lower lid retractors

14. LID RETRACTION

15. PROPTOSIS
 SIGNS
 Axial, Unilateral /
Bilateral Symmetrical /
Asymmetrical permanent
 May compromise lid
closure
 Corneal ulceration due
to exposure

17. MANAGEMENT
Steroid
Radiotherapy
Combined therapy
Surgical decompression

18. OPTIC NEUROPATHY
 Caused by compression optic nerve or its
blood supply at the orbital apex by
congested and enlarged recti.
 Clinical features
 Decrease visual acuity
 Decrease colour vision
 RAPD
 Visual field defects
 Increase IOP
 Swollen disc

20. Treatment
 IV Methyl prednisolone
 Surgical decompression
 Radiotherapy

21. RESTRICTIVE MYOPATHY
 Caused by inflammatory edema and
later by fibrosis of extra ocular
muscles.
 Ocular Motility Defects
Elevation defects
Abduction defects
Adduction defects
Depression defects

23. MANAGEMENT
Surgery __ Recession of inferior
and / or medial recti
Botulinum toxin injection

24. RESTRICTIVE MYOPATHY