CLINICAL REVIEW-13 - DIAGNOSIS AND MANAGEMENT OF GRAVES OPHTHALMOPATHY

Graves’ ophthalmopathy is a potentially sight-threatening and disfiguring disease. Subtle or overt clinical evidence of ophthalmopathy is present in 25–50% of patients with Graves’ hyperthyroidism. However, sensitive imaging techniques such as orbital ultrasonography and computerized tomography have demonstrated evidence of ocular involvement in the vast majority of hyperthyroid patients. Conversely, careful study of apparently euthyroid patients with Graves’ ophthalmopathy indicates that greater than 70% either presently have, or will eventually develop, subtle or overt thyroid dysfunction. At the present time, there are no means to prevent Graves’ ophthalmopathy and treatment for established, symptomatic disease is only palliative. Patients with Graves’ ophthalmopathy frequently complain of an ocular foreign body sensation, lacrimation, photophobia, blurring of vision, double vision, or deep orbital pressure. Typical findings on examination include periorbital and lid edema, lid retraction, lid lag, conjunctival chemosis and injection, exposure keratitis, and extraocular muscle dysfunction. Occasionally severe exposure keratitis results in corneal ulceration. Additionally. © 1990 by The Endocrine Society.