THYROID EYE DISEASE

It as an autoimmune disorder and is most common cause of unilateral and bilateral proptosis. 

It can happen without any thyroid dysfunction. 

Clinical features:

systemic: 

1. palpitations

2. heat intolerance

3. GIT upset

4. tremors

5. excessive sweating

6. thyroid enlargement

ocular

i. Bilateral exophthalmos with associated exposure keratitis.

ii. Dalrymple’s sign—There is peculiar stare due to retraction of the upper lid

iii. von Graefe’s sign—Upper lid lags on downward movements of the eyeball.

iv. Stellwag’s sign—There is infrequent and incomplete blinking.

v. Mobius’s sign—There is weakness of convergence

vi. Jellinek’s sign—There is increased pigmentation of lids.

vii. Joffroy’s sign—There is poor forehead wrinkling on looking up.

viii. kocher sign: frightened look

Assessment:

Most important complications are exposure keratopathy and optic neuropathy.

Treatment consists of medical and surgical. 

Medical treatment consists of 

• oral and intravenous steroids. 

• systemic antithyroid drugs and iodide

• exposed cornea with lubricants and tarsorrhapy

Surgical treatment consists one, two, three and 4 wall removal.

Radiotherapy is also an option. It may take time to take effect.