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Thyroid Ophthalmopathy

  1. May or may not be associated with hyperthyroidism
  2. C/F – Five common features are
  1. Eyelid retraction: Most common finding
    1. Lid sign in thyroid ophthalmopathy:
      1. Dalrymple sign- lid retraction in primary gaze*
      2. Von Graefe sign- lid lag*
      3. Kocher’s sign –staring appearance of eye*
      4. Griffith sign : Lid lag of lower lid in upgaze.*
      5. Stellwag’s sign: Decrease in frequency of blinking reflex.*
      6. Enroth sign : Puffy swelling of lids.*
      7. Gifford sign : Difficult eversion of upper lid.*
    2. Treatment:  For lid retraction
      1. Topical guanethidine-  depletes sympathetic storage
      2. Chemodenervation of LPS by botulinum toxin*
  2. Soft tissue Involvement
    1. Conjunctival injection
    2. Chemosis
    3. Edema and fullness of eyelids
    4. Superior limbic kerato conjunctivitis
      1. Treatment
        1. Tear substitutes
        2. For superior limbic keratoconjunctivitis –cyclommune 0.02%,acetyl cysteine 5% and Thermocautrisation
  3. Proptosis- Is axial
    1. Treatment.: If progressive and painful-
      1. Steroids          
      2. Radio Therapy
      3. Surgery
    2. Surgical order first for proptosis then for squint then for lid if required
  4. Dysthyroid optic neuropathy – Due to compression of optic nerve at orbital apex by enlarged recti. Presents with all features of optic nerve disease.
    1. Treatment :  is same as in proptosis
  5. Restrictive Thyroid Myopathy – Patient presents with diplopia.
    Ophthalmoplegia is due to muscle contraction and not palsy sequence of involvement of muscle is–
    IR  MR  SR LR*
    (Mnemomc I Am So Lucky)

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