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This 25-year-old woman presented with a five-month history of redness, swelling, and blurred vision in her left eye. On examination, the left eyelids were swollen and discolored, the conjunctiva edematous and injected, and the globe moderately proptotic. Studies for neoplasm and infection were negative, and results of thyroid function tests were normal. The radioiodine uptake, however, was not suppressed by administration of triiodothyronine.
A form of infiltrative ophthalmopathy characterized by swollen extraocular muscles, increased amounts of retroorbital fat, and absence of toxic goiter. Early symptoms include a sense of irritation in the eyes, excessive tearing, and blurred vision. Exophthalmos, ordinarily bilateral, is the most common finding, along with reddened lids and weakness of the extraocular muscles. The course is variable and unpredictable. Symptomatic care often suffices in mild cases, while glucocorticoids, external radiation, or both are useful in others. For extreme cases, orbital decompression may become necessary.
The patient shown responded promptly but incompletely to large doses of glucocorticoids (image below).
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This work is licensed by Herbert L. Fred, MD and Hendrik A. van Dijk under a Creative Commons Attribution License (CC-BY 2.0), and is an Open Educational Resource.
Last edited by Frederick Moody on Dec 8, 2008 7:40 pm -0600.
