Sympathetic Overactivity in the Development of Eyelid Retraction in a Patient with Euthyroid Graves' Disease Evaluated by Accommodation.

Abstract

Abstract.It is known that measurement of accommodation is useful to evaluate the sympathetic activity of intraocular muscles. To find if sympathetic overactivity is involved in eyelid retraction in euthyroid Graves' disease, we measured accommodation in two patients with this disease, whose serum concentrations of free T3, free T4 and TSH were within reference ranges. Accommodation was measured with a computer-assisted infrared optometer with an iriscoder, and the results were expressed as the change in the eye's refractive power (in diopters) in response to the movement of a target beam. In patient 1, the accommodation amplitude was low, indicating sympathetic overactivity. This amplitude rose to near the reference range when timolol maleate drops were used, and the eyelid retraction disappeared when guanethidine drops were given. During the use of guanethidine drops, accommodation remained normal. In patient 2, who had normal accommodation, eyelid retraction did not change with guanethidine administration, but improved with intravenous methylprednisolone pulse therapy. These two cases suggested that even in euthyroid Graves' disease, eyelid retraction is caused by sympathetic overactivity, and pulse therapy with methylprednisolone may be effective for eyelid retraction when guanethidine drops are not effective.

Graves’ orbitopathy development in thyroid cancer patients: A 16-year nationwide cohort study in South Korea

“…In hyperthyroidism, TSH-R-Ab on thyroid follicles excessively induce thyroid hormones, demonstrating that the autoimmune reaction against orbital soft tissue and sympathetic stimulation from thyroid hormones prompt GO symptoms. 7,30,31 Our result did not con rm differences among daily thyroid hormone supplement doses between GO and non-GO patients. However, further study with a larger cohort is needed to evaluate this relationship.…”

Thyroid Eye Disease

“…It may present as an isolated finding or in association with exophthalmos [141]. Upper eyelid retraction may result from increased sympathomimetic tone but may also be the consequence of eyelid fibrosis [142][143][144][145]. Retraction of the lower lid usually correlates with the severity of proptosis [146].…”

Ophthalmic manifestations of endocrine disorders: approaches and medical management

“…The characteristic thyroid eye stare may be a combination of the exophthalmos and eyelid retraction (Table 2). Pathophysiologically, orbital fibroblasts demonstrate upregulation of glycosaminoglycan production [30,31].…”

“…Thus, if correction of eyelid retraction is planned, it should follow strabismus surgery. Aggressive ocular surface lubrication is required in all patients due to risk of exposure keratopathy [31][32][33][34].…”