Thyroid Eye Disease
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Introduction

Typically associated with the signs of Grave’s disease (goitre, acropathy, hyperthyroidism and pretibial myxoedema).
Autoimmune orbital disease may occur without thyroid autoantibodies

Clinical features

  • Swelling of the eyelids
  • Oedema (chemosis) and engorgement of vessels of conjunctiva
  • Exposure of the cornea (loss of blink, apparent lid retraction)
  • Pronounced exophthalmos (if absent because tight orbital septum may restrain contents and lead to raised intraorbital pressure and optic nerve compression)
  • Restricted eye movements (infiltration of muscles by inflammatory cells, inflammation, oedema and fibrosis)
  • Optic neuropathy (fundal vascular congestion, swelling or atrophy of disc)

Management

Includes excluding or treating thyroid dysfunction, smoking cessation and artificial tears/ointments
o   Lid retraction can be reduced by guanethidine drops (relax smooth muscle)
o   If corneal exposure threatens sight, tarsoraphy performed.
o   In serious disease with corneal problems or pressure on CN II: high dose steroids, surgical orbital decompression and radiotherapy.

References

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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) currently works as a GP Registrar and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

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