scholarly journals The Influence of Juvenile Graves’ Ophthalmopathy on Graves’ Disease Course

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Jurate Jankauskiene ◽  
Dalia Jarusaitiene
Keyword(s):  
Soft Tissue ◽  
Palpebral Fissure ◽  
Clinical Activity ◽  
Graves Disease ◽  
Eyelid Retraction ◽  
Upper Eyelid ◽  
Autoimmune Thyroid ◽  
Graves Ophthalmopathy ◽  
Upper Eyelid Retraction ◽  
First Remission

Purpose. To investigate juvenile Graves’ ophthalmopathy (GO) signs and compare Graves’ disease (GD) course in patients with or without GO. Patients and Methods. There were analyzed data (visual acuity, proptosis, palpebral fissure measurements, clinical activity score (CAS), and the course of GD) of 67 children who have been newly diagnosed with GD. 26.9% of patients with GD had signs of ophthalmopathy (GO+), and 73.1% were without ophthalmopathy (GO−). Results. Upper eyelid retraction (72.3%), proptosis (66.7%), and soft tissue changes (27.8−38.9%) were in GO+ patients. The palpebral fissure, CAS, and proptosis values were greater in the GO+ group than in the GO− group (p<0.001). GD course in GO+ patients was longer than that in GO− patients (p<0.001). The duration of the first remission was longer in GO− than in GO+ patients (p<0.001). The duration of first remission was longer than one year for 61.2% in GO− and 33.3% in GO+ patients (p<0.02). Conclusion. The common manifestations of juvenile GO patients were upper eyelid retraction, proptosis, and soft tissue involvement. The study demonstrates that pediatric patients with GO are more likely to have a severe course of autoimmune thyroid disease.

Course of upper eyelid retraction in thyroid eye disease

2019 ◽  
Vol 104 (2) ◽  
pp. 254-259
Author(s):  
Dong Cheol Lee ◽  
Stephanie M Young ◽  
Yoon-Duck Kim ◽  
Kyung In Woo
Keyword(s):  
Positive Family History ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Eye Disease ◽  
Eye Disease ◽  
Clinical Activity ◽  
Eyelid Retraction ◽  
Tertiary Institution ◽  
Upper Eyelid ◽  
Upper Eyelid Retraction ◽  
History Of

AimsTo evaluate the natural course of upper eyelid retraction (UER) in patients with thyroid eye disease (TED) and factors affecting its course.MethodsRetrospective non-interventional cohort study in a single tertiary institution from March 2006 to March 2015 on patients with TED with (1) unilateral or bilateral UER within 6 months from initial presentation, and (2) no prior interventions nor surgical treatment for their UER. Main outcomes and measures were mean margin reflex distance 1 (MRD1) and factors associated with UER improvement.ResultsThere were a total of 61 patients and 81 eyes (41 unilateral and 20 bilateral UER). Mean age was 42.3±15.1 years. Mean MRD1 decreased from 6.1 mm at presentation to 4.8 mm at 12 months, and 4.4 mm at 24 months. The proportion of eyes with normalisation of lid height increased from 0% at presentation to 22.2% at 6 months, 37.0% at 12 months and 49.4% at 24 months. Mean time to normalisation of MRD1 was 18.0±12.4 months. A positive family history of TED was found to be associated with a 6.2 times lower likelihood of normalisation. Change in exophthalmometry, clinical activity score and thyroid-stimulating immunoglobulin were significantly correlated to change in MRD1 (p<0.05). There was no correlation between change in MRD1 and thyroid-stimulating hormone receptor antibodies.ConclusionAn improved knowledge of the natural history of UER in TED will allow us to better decide and evaluate the optimal management for such patients.

Graves’ ophthalmopathy and dermopathy

2011 ◽  
pp. 495-508
Author(s):  
Wilmar M Wiersinga
Keyword(s):  
Optic Neuropathy ◽  
Eyelid Retraction ◽  
Upper Eyelid ◽  
Eye Muscle ◽  
Dry Eyes ◽  
Graves Ophthalmopathy ◽  
Class 1 ◽  
Sight Loss ◽  
Upper Eyelid Retraction ◽  
Visual Blurring

The many and often disfiguring features of a typical patient with Graves’ ophthalmopathy are obvious at first glance (Fig. 3.3.10.1). The changed appearance of the patient has a profound effect on their emotional and social status. The various signs and symptoms can be described according to the NO SPECS classification (1) (Box 3.3.10.1). Class 1 signs can be present in any patient with thyrotoxicosis regardless of its cause. Upper eyelid retraction causes stare and lid lag on downward gaze (the latter is the well-known von Graefe’s sign). Soft tissue involvement (class 2) comprises swelling and redness of eyelids, conjunctiva, and caruncle. Symptoms are a gritty sandy sensation in the eyes, retrobulbar pressure, lacrimation, photophobia, and blurring of vision. Proptosis (class 3) can be quite marked. Upper eyelid retraction by itself may already give the impression of exophthalmos. Extraocular muscle involvement (class 4) may result in aberrant position of the globe, or fixation of the globe in extreme cases. More common is limitation of eye muscle movements in certain directions of gaze, especially in upward gaze; it is usually associated with diplopia. Diplopia will not occur if the vision of one eye is very low (e.g. in amblyopia), or if the impairment of eye muscle motility is strictly symmetrical. Patients may correct for double vision by tilting the head, usually backwards and sideways; the ocular torticollis often leads to neck pain and headache. Corneal involvement (class 5) occurs through overexposure of the cornea due to lid lag, lid retraction, and exophthalmos, easily leading to dry eyes and keratitis. Lagophthalmos is often noted first by the patient’s partner because of incomplete closure of the eyelids during sleep. Sight loss (class 6) due to optic nerve involvement is the most serious feature, often referred to as dysthyroid optic neuropathy (DON). Besides the decrease of visual acuity, there may be loss of colour vision and visual field defects. Visual blurring may disappear after blinking (caused by alteration of the tear film on the surface of the cornea due to lacrimation or dry eyes) or after closing one eye (attributable to eye muscle imbalance). Visual blurring that persists is of great concern as it may indicate optic neuropathy (2).

Results of Müllerotomy and Levator Aponeurosis Transposition for the Correction of Upper Eyelid Retraction in Graves Disease

Ophthalmology ◽  
1995 ◽  
Vol 102 (3) ◽  
pp. 483-492 ◽  
Author(s):  
Emily J. Ceisler ◽  
Jurij R. Bilyk ◽  
Peter A.D. Rubin ◽  
William R. Burks ◽  
John W. Shore
Keyword(s):  
Graves Disease ◽  
Eyelid Retraction ◽  
Upper Eyelid ◽  
Upper Eyelid Retraction ◽  
Levator Aponeurosis
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