1/22. Two cases of refractory endocrine ophthalmopathy successfully treated with extracorporeal immunoadsorption.Endocrine ophthalmopathy (EO) is a severe disease entity that is characterized by retrobulbar swelling due to accumulation of glycosaminoglycans on an autoimmune basis. This disorder can lead to the loss of vision and often is resistant to conventional therapy. There is a relation to Graves' hyperthyroidism, but probably no close association. Two patients with severe EO that was resistant to usual therapeutic approaches including steroids and radiological and surgical measures underwent a 20 session course of intensive immunoadsorption therapy (Plasmaselect/Therasorb Anti-IgG) with a mean 2- to 3-fold plasma volume treated. After the first sessions, both patients voiced an impressive relief of their major symptoms, which was confirmed by ophthalmological investigation. Throughout the time of therapy until present, these patients have remained at their respective levels of improvement. We consider immunoadsorption an effective therapeutic opportunity in severe EO resistant to conventional treatment.- - - - - - - - - - ranking = 1keywords = ophthalmopathy (Clic here for more details about this article) |
2/22. Orbital lymphoma misdiagnosed as Graves' ophthalmopathy.OBJECTIVE: To describe a case of bilateral orbital lymphoma mistakenly diagnosed as Graves' ophthalmopathy. methods: We present a case report, with laboratory data and photographic documentation, and discuss the differential diagnosis in patients with orbital masses. RESULTS: A 65-year-old man with bilateral exophthalmos and substantial weight loss was referred to the Endocrine Clinic for evaluation of possible Graves' disease. A 6-cm mass was detected in the left axilla. biopsy of this mass revealed the histopathologic diagnosis of anaplastic B-cell lymphoma. Treatment with intrathecally administered methotrexate and orally administered dexamethasone promptly resulted in decreased proptosis. CONCLUSION: The most frequent cause of bilateral proptosis is Graves' ophthalmopathy, and when it is associated with weight loss in an elderly patient, the initial diagnostic consideration is thyrotoxic Graves' disease. This case should remind physicians that bilateral orbital lymphoma, although uncommon, may mimic Graves' ophthalmopathy.- - - - - - - - - - ranking = 1.4keywords = ophthalmopathy (Clic here for more details about this article) |
3/22. prenatal diagnosis of Pierre-Robin sequence as part of Stickler syndrome.Stickler syndrome or hereditary progressive arthro-ophthalmopathy, is an autosomal dominant condition characterized by ocular manifestations, arthritic changes, orofacial features and deafness, in variable degrees.We report the first case of prenatal diagnosis of Stickler syndrome in a child with a Pierre-Robin sequence (PRS) causing a polyhydramnios. When isolated polyhydramnios is not explained by immunological, metabolic or infectious causes, swallowing difficulty due to PRS must be considered. As PRS is aetiologically heterogeneous, the prognosis depends on the cause. Genetic investigations and familial history must be taken into account. Here, in a context of familial Stickler syndrome, making the prenatal diagnosis of PRS as part of Stickler syndrome allowed us to reassure the parents and to anticipate airway trouble at the child's birth.- - - - - - - - - - ranking = 0.2keywords = ophthalmopathy (Clic here for more details about this article) |
4/22. Paraneoplastic bilateral proptosis in a case of non-small cell lung cancer.We report the case of a 51-year-old woman with a large cell bronchial carcinoma with neuroendocrine differentiation (T3N0M0, stage IIB) and bilateral exophthalmos. A CT of the orbitae was compatible with graves ophthalmopathy, but neither abnormalities in thyroid function nor thyroid antibodies could be found. The proptosis normalized 10 days after tumor resection. We conclude that the most likely cause of the reversible proptosis in this patient is paraneoplastic, a condition not previously described in the English-language literature.- - - - - - - - - - ranking = 0.2keywords = ophthalmopathy (Clic here for more details about this article) |
5/22. Triad of exophthalmos, pretibial myxedema, and acropachy in a patient with Graves' disease.Graves' disease is an autoimmune disorder of the thyroid gland with characteristic peripheral manifestations. The most common clinical findings include ophthalmopathy in 30% of patients, dermopathy (pretibial myxedema) in 4% of patients, and thyroid acropachy in 1% of patients. The triad of exophthalmos, pretibial myxedema, and acropachy occurs in less than 1% of patients. We present a case of Graves' disease with the clinical triad of eye disease, dermopathy, and acropachy.- - - - - - - - - - ranking = 0.2keywords = ophthalmopathy (Clic here for more details about this article) |
6/22. Severe Graves' ophthalmopathy in pregnancy.BACKGROUND: Thyroid ophthalmopathy is a rare extrathyroidal complication most commonly associated with Graves' disease. The disease course ranges from mild to severe, with severe cases resulting in major visual impairment and facial disfigurement. CASE: A 22-year-old primigravida developed severe thyroid ophthalmopathy during pregnancy, requiring high-dose steroids and surgical orbital wall decompression to restore visual acuity. CONCLUSION: Severe thyroid ophthalmopathy can occur in the euthyroid pregnant patient. Corticosteroid therapy and surgical intervention may be required during pregnancy in this clinical scenario.- - - - - - - - - - ranking = 1.4keywords = ophthalmopathy (Clic here for more details about this article) |
7/22. Euthyroid Graves' ophthalmopathy with negative autoantibodies.Graves' disease is an autoimmune-based hyperthyroidism in which a number of different antibodies directed against thyroid tissue plays a role. Graves' ophthalmopathy is thought to be a consequence of this autoimmune basis and occurs in some patients with Graves' disease. On occasional cases, the disease may present only with ophthalmopathy without hyperthyroidism. A 32-year-old woman with euthyroid Graves' ophthalmopathy and negative thyroid autoantibodies, including TSH receptor antibody, is presented here.- - - - - - - - - - ranking = 1.4keywords = ophthalmopathy (Clic here for more details about this article) |
8/22. A sphenoid en plaque meningioma aggravates exophthalmos in a patient with thyroid ophthalmopathy.PURPOSE: To describe the rare case of a patient with thyroid ophthalmopathy whose unilateral aggravated exophthalmos was caused by the development of an ipsilateral sphenoid wing en plaque meningioma. methods: Case report. RESULTS: The ophthalmologic examination included visual acuity assessment, anterior segment examination, funduscopy, ocular motility examination, and exophthalmometry. magnetic resonance imaging (MRI) of the brain and orbit revealed the existence of a sphenoid meningioma. Removal of the tumor through a pterional craniotomy was performed. The histologic examination showed that it was an en plaque meningioma. There were no postoperative complications and no recurrence of the tumor was revealed 24 months after the operation. CONCLUSIONS: Detailed ophthalmologic examination and MRI of the brain and orbit are necessary in every patient with deterioration of the exophthalmos even if the suggestive cause seems obvious.- - - - - - - - - - ranking = 1keywords = ophthalmopathy (Clic here for more details about this article) |
9/22. Concomitant euthyroid Graves' ophthalmopathy and isolated ocular myasthenia gravis.A 44 year old diabetic woman presented with diplopia and bilateral ptosis and mild exophthalmos. The patient was clinically euthyroid, the baseline thyroid function tests were normal, but the thyroid stimulating hormone response to thyrotrophin releasing hormone was flat. Computed tomographic scan and magnetic resonance imaging of the orbits showed left medial and inferior rectus muscle thickening, more prominent on the left side, consistent with Graves' disease. The tensilon stimulation test resulted in resolution of the ptosis and partial improvement of the ophthalmoplegia. The single fibre electromyography was consistent with a defect in neuromuscular transmission. However, forced duction test was normal and anti-acetylcholine receptor antibodies were undetectable. Significant improvement of the extraocular muscle function and resolution of the right ptosis had resulted from anticholinesterase therapy. These findings and the clinical response to therapy were consistent with concomitant euthyroid Graves' ophthalmopathy and ocular myasthenia gravis. Coexistent isolated ocular myasthenia gravis and Graves' ophthalmopathy is rare and should be considered in patients with findings of ocular myasthenia and extraocular muscle dysfunction.- - - - - - - - - - ranking = 1.2keywords = ophthalmopathy (Clic here for more details about this article) |
10/22. ultrasonography and computer tomography in orbital diagnosis. With special reference to dysthyroid ophthalmopathy.A report is given on a series of 162 patients referred for ultrasound examination (US, A-mode) due to orbital disease. 101 also had computerized tomography (CT, Emi scanner Mark I, 160 X 160 matrix, 8 mm sections), the results of which were emphasized in a recent publication (Gyldensted et al. 1977). The present approach is primarily clinical. With histopathological confirmation in only 40% of the cases, it is difficult to give exact values for diagnostic accuracy, but it appeared to be above 90% for CT, and close to this value for US (depending on, of course, how specified the diagnostic predictions were). Dysthyroid ophthalmopathy (DO, orbital Graves' disease, endocrine exophthalmos) was the most frequent cause of unilateral protrusion (24 cases). In some such cases "tumour-positive" CT scans represent a diagnostic pitfall, unless the examiner is familiar with the clinical features of DO. In the present series, for example, one of the DO cases had transcranial exploration of the orbit. The two--indeed valuable--non-invasive methods (CT and US) should be assessed in combination, and also combined with the classic clinical evaluation of the patient.- - - - - - - - - - ranking = 1keywords = ophthalmopathy (Clic here for more details about this article) |
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