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[Globe subluxation in thyroid orbitopathy].

Nir Seider1, Benjamin Miller, Michael Gilboa

  • 1The Alberto Moscona Department of Ophthalmology, Rambam Medical Center, Haifa, Israel. zayder@netvision.net.il

Harefuah
|February 8, 2008
PubMed
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Acute globe subluxation, a rare complication of Grave's disease, can occur in myogenic (type II) thyroid orbitopathy due to extraocular muscle enlargement and orbital congestion. This case highlights a distinct mechanism from previous reports.

Area of Science:

  • Ophthalmology
  • Endocrinology
  • Internal Medicine

Background:

  • Grave's disease is an autoimmune disorder that can lead to thyroid orbitopathy.
  • Thyroid orbitopathy encompasses various clinical presentations, including lipogenic (type I) and myogenic (type II) forms.
  • Acute globe subluxation is a rare but severe complication of thyroid orbitopathy.

Observation:

  • A female patient with a 10-year history of poorly controlled Grave's disease presented with acute globe subluxation.
  • The patient exhibited significant involvement of extraocular muscles, characteristic of myogenic (type II) thyroid orbitopathy.
  • Radiographic findings revealed crowding of the orbital apex, impaired venous outflow, and severe orbital congestion.

Findings:

  • This case represents the first documented instance of acute globe subluxation in myogenic (type II) thyroid orbitopathy.

Related Experiment Videos

  • The mechanism differs from previously reported cases attributed to orbital fat enlargement in lipogenic (type I) orbitopathy.
  • Findings suggest that extraocular muscle hypertrophy and subsequent orbital apex crowding can precipitate globe subluxation.

    • Implications:

    • Acute globe subluxation should be considered in the differential diagnosis of patients with myogenic thyroid orbitopathy presenting with acute orbital symptoms.
    • Understanding the specific mechanisms of orbitopathy is crucial for accurate diagnosis and management.
    • This report expands the known clinical spectrum of Grave's disease complications and emphasizes the importance of comprehensive ophthalmologic evaluation.