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.