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Enfermedad de Graves que se presenta con proptosis bilateral aguda y dolorosa, ptosis, oftalmoplegia y pérdida visual
Lancet (London, England)
|August 25, 1984
Resumen
La enfermedad ocular distiroidea atípica puede imitar la celulitis orbital en mujeres de mediana edad. Las tomografías computarizadas tempranas y los esteroides sistémicos son cruciales para el diagnóstico rápido y la prevención de la pérdida de visión.
Área de la Ciencia:
- Oftalmología Oftalmología.
- Endocrinología Endocrinología.
Sus antecedentes:
- La proposis dolorosa aguda bilateral, la ptosis, la oftalmoplegia y la pérdida visual son síntomas graves.
- La celulitis orbital es un diagnóstico inicial común para estos síntomas.
- La enfermedad ocular distiroidea atípica puede presentarse de manera similar, pero requiere un manejo diferente.
Objetivo del estudio:
- Para resaltar la importancia de considerar la enfermedad ocular distiroidea atípica en los casos de proposis dolorosa aguda bilateral.
- Para enfatizar el valor diagnóstico de las tomografías computarizadas orbitales tempranas.
- Para subrayar los beneficios terapéuticos de los esteroides sistémicos en esta condición.
Principales métodos:
- Informes de caso de dos mujeres de mediana edad con proptosis bilateral aguda dolorosa.
- Tratamiento inicial con antibióticos sistémicos, seguido de tomografías computarizadas orbitales.
- Sustitución de antibióticos por esteroides sistémicos en dosis altas basados en los hallazgos de la TC.
Principales resultados:
- Las tomografías computarizadas orbitales revelaron músculos extraoculares agrandados, lo que sugiere una enfermedad ocular distiroidea.
- Los pacientes no respondieron a los antibióticos, pero mostraron una rápida mejora con los esteroides sistémicos.
- Se observó una reducción del tamaño del músculo extraocular en las tomografías computarizadas de seguimiento.
- Un paciente desarrolló hipotiroidismo, el otro hipertiroidismo.
Conclusiones:
- La proptosis dolorosa aguda bilateral justifica una TC orbital temprana para descartar la enfermedad ocular distiroidea atípica.
- La administración inmediata de esteroides sistémicos es vital para prevenir la pérdida visual por daño al nervio óptico.
- En el diagnóstico diferencial de la proptosis aguda dolorosa, se debe considerar la enfermedad ocular distiroidea, incluso sin otros signos típicos.
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