Original acquisition in the pathogenesis and the treatment of endocrine ophthalmopathy

In the present work, we demonstrate in the serum of patients with progressive exophthalmos, the presence of circulating immunoglobulin which is able to induce an experimental exophthalmos in goldfish. This immunoglobulin disappears when exophthalmos becomes residual. In parallel, we describe an easy technique for the measurement of delayed hypersensitivity which is positive for thyroid or retroorbital antigens in progressive exophthalmos but negative in residual exophthalmos. We also demonstrate in patients with exophthalmos an increase in urinary glycosaminoglycans. We propose a new therapeutic approach in treatment of acute exophthalmos which consists of intensive plasma exchange followed during a few months, by the administration of small amounts of corticosteroids. The plasma exchange mechanism consists of the extraction of the antibody directed against retroorbital eye muscle antigen. In addition, plasma exchange produces the extraction of glycosaminoglycans from retroorbital tissue. These hygroscopic molecules are responsible for the marked oedema in retroorbital tissue.