Sympathetic overactivity of intraocular muscles evaluated by accommodation in patients with hyperthyroidism

Sympathetic overactivity occurs in Graves' disease, but little is known about autonomic nervous function in the eyes of subjects with this disease. We examined this function of the intraocular muscles in 12 patients with hyperthyroid Graves' disease and 12 healthy controls. Pupil size, pupillary unrest, and accommodation were measured with a computer-assisted infrared optometer and pupillometer. The mean and the coefficient of variation of the areas of the pupils were used to express pupil size and the degree of pupillary unrest, respectively. Accommodation was measured with the target light beam moving slowly and steadily, or instantaneously, and the results are expressed as the change in the eye's refractive power in response to these movements. The mean pupil size of the patients was not different from that of the controls. Pupillary unrest in the patients was smaller than in the controls. Accommodation in the patients was lower than that of the controls. Five patients were examined again 3 months later when they became euthyroid; pupillary unrest and accommodation had improved in all five patients. There were no significant differences in the activity of sympathetic nerves governing intraocular muscles in patients with or without eyelid retraction. These results indicate that intraocular muscles are sympathetically overactive in patients with hyperthyroidism, and suggest that eyelid retraction is not caused by sympathetic overactivity alone, but by another factor or factors, in addition.