Dysthyroid Optic Neuropathy

Trobe, Jonathan D.

doi:10.1001/archopht.1978.03910060033007

Cited by 202 publications

(41 citation statements)

References 29 publications

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“…Optic neuropathy indicated by a decrease in the visual acuity is an important complication (Gorman 1978;Trobe et al 1978;Trobe 1981). The reason is probably pressure of the muscle cone on the optic nerve which is visualized on computerized tomography (Enzmann et al 1976).…”

Section: Discussioncontrasting

confidence: 42%

“…Because of this pathogenesis orbital decompression would seem to be a logical approach and good results are indeed obtained with this method (Gorman et al 1974;Panzo & Tomsak 1983). Good results have also been reported with glucocorticoids (Trobe et al 1978;Panzo & Tomsak 1983) and retrobulbar irradiation (Kriss et al 1975) but relapses occur. Amelioration of the visual acuity occurred in 7 eyes of the 6 patients with optic neuropathy in the present material.…”

Section: Discussionsupporting

confidence: 40%

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Orbital decompression in endocrine exophthalmos of Graves' disease

Lamberg¹,

Grahne²,

Tommila³

et al. 1985

Acta Endocrinologica

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Transantral decompression was performed bilaterally in 27 and unilaterally in 3 patients with endocrine exophthalmos of Graves' disease. In 28 patients there was an immediate reduction of proptosis and in about half of the patients in addition a marked decrease in chemosis and conjunctival injection indicating that these signs were mostly due to orbital vascular congestion. In one patient with exophthalmos of more than 2 years duration and progressive swelling of the eye muscles no response was observed. In another patient decompression did not reduce proptosis which, however, 4 months later responded to retrobulbar irradiation. In one further patient much more marked reduction of proptosis and disappearance of persistent periorbital swellings were obtained after glucocorticoid treatment given half a year after decompression. Postoperatively diplopia occurred in about half of the patients but corrective operations were required only in a quarter of the patients. Transantral decompression is an effective method for rapid treatment of progressive exophthalmos of Graves' disease. In patients with unilateral exophthalmos the asymmetry may be reversed after unilateral operation. The authors use decompression not only in the most severe cases (categories 5 and 6a\p=n-\c according to the classification of the American Thyroid Association) but also in less severe cases (categories 2b\p=n-\c and 3b\p=n-\c) when there is a steady progression as a primary treatment possibly combined with other forms of therapy.

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Section: Discussioncontrasting

confidence: 42%

Section: Discussionsupporting

confidence: 40%

Orbital decompression in endocrine exophthalmos of Graves' disease

Lamberg¹,

Grahne²,

Tommila³

et al. 1985

Acta Endocrinologica

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“…The incidence of exophthalmos in patients with hyperthyroid disease ranges from 40% to 75% but fortunately only 2% to 5% of these patients have develop¬ ment of optic nerve involvement with loss of vision. [1][2] The clinical course of Graves' ophthalmopathy may be completely independent from the clinical course of the as¬ sociated thyroid disease. In fact, the eye disease may occur long after the thyroid disease has been appropriately treated.…”

mentioning

confidence: 44%

“…Transantral decompression of the orbit offers a safe and effective therapeutic modality for vision-threatening Graves' ophthalmopathy. ( Graves' disease is a multisystem disorder of unknown etiology that is characterized by one or more of the following: (1) hyperthyroidism associated with diffuse hyperplasia of the thyroid gland, (2) infiltrative ophthal¬ mopathy, and (3) infiltrative dermopathy (localized pretibial myxedema). The incidence of exophthalmos in patients with hyperthyroid disease ranges from 40% to 75% but fortunately only 2% to 5% of these patients have develop¬ ment of optic nerve involvement with loss of vision.…”

mentioning

confidence: 51%

Orbital Decompression for Preservation of Vision in Graves' Ophthalmopathy

Girod¹,

Orcutt²,

Cummings³

1993

Archives of Otolaryngology - Head and Neck Surgery

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“…Typically, orbital signs and symptoms including proptosis, chemosis, congestion of episcleral and conjunctival blood vessels, elevation of intraocular pressure, limitation of extraocular motility, and orbital pain are present. Degradation of the corneal surface can also cause loss of visual acuity 4. Computerised tomography (CT) can establish the degree of extraocular muscle and orbital fat enlargement, exclude coexisting orbital pathology, clarify a confounding clinical picture, and aid planning of surgery or radiotherapy.…”

mentioning

confidence: 99%

Reversal of dysthyroid optic neuropathy following orbital fat decompression

Kazim

Trokel²,

Acaroğlu³

et al. 2000

British Journal of Ophthalmology

118

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Aims-To document the successful treatment of five patients with dysthyroid optic neuropathy by orbital fat decompression instead of orbital bone decompression after failed medical therapy. Methods-Eight orbits of five patients with dysthyroid optic neuropathy were selected for orbital fat decompression as an alternative to bone removal decompression. Treatment with systemic corticosteroids and/or orbital radiotherapy was either unsuccessful or contraindicated in each case. All patients satisfied clinical indications for orbital bone decompression to reverse the optic neuropathy. High resolution computerised tomographic (CT) scans were performed in all cases and in each case showed signs of enlargement of the orbital fat compartment. As an alternative to bone decompression, orbital fat decompression was performed on all eight orbits. Results-Orbital fat decompression was performed on five patients (eight orbits) with optic neuropathy. Optic neuropathy was reversed in all cases. There were no cases of postoperative diplopia, enophthalmos, globe ptosis, or anaesthesia. All patients were followed for a minimum of 1 year. Conclusions-In a subset of patients with an enlarged orbital fat compartment and in whom extraocular muscle enlargement is not the solitary cause of optic neuropathy, fat decompression is a surgical alternative to bony decompression. (Br J Ophthalmol 2000;84:600-605)

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Dysthyroid Optic Neuropathy

Cited by 202 publications

References 29 publications

Orbital decompression in endocrine exophthalmos of Graves' disease

Orbital decompression in endocrine exophthalmos of Graves' disease

Orbital Decompression for Preservation of Vision in Graves' Ophthalmopathy

Reversal of dysthyroid optic neuropathy following orbital fat decompression

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