OPHTHALMIC MANIFESTATION OF GRAVESʹ DISEASE

Objective: The purpose of this study is to find out various ophthalmic sign in patients with Gravesʹ disease, their relative frequency and the percentage of patients severely affected resulting in loss of vision.Material and Methods: This prospective study is based on finding ophthalmic signs in one hundred patients with established Gravesʹ disease attending ophthalmic and medical units of Khyber Teaching Hospital Peshawar as well as Institute of Radiotherapy and Nuclear Medicine (IRNUM) Peshawar. The total duration of study is seventeen months i.e. from August 1994 to December 1995. For study, a proforma has been set up giving all the possible ophthalmic signs which may be present in patients with Gravesʹ disease. Patientʹs name, age, sex and address were recorded. The proforma also gives information about the mode of presentation that how and when the patients with Gravesʹ disease seek medical advice.The age-sex distribution of Gravesʹ disease and the percentage of patients with positive family history and smoking history are also sorted out. Relation of thyroid hormone level to severity of ophthalmic signs and percentage of euthyroid patients with ophthalmopathy is also taken into consideration. Moreover unilateral and bilateral presentation is also compared.Results: A total of one hundred patients with Gravesʹ disease were examined, over a period of seventeen months. These patients were examined thoroughly for possible ophthalmic signs. Eighty four patients were female and 16 patients were male. Family history was positive in 32 percent of patients. Association between smoking habit and ophthalmopathy could not be established. Their mean age was 45 years (age range 15-60 years). Usually the patients with Gravesʹ disease sought medical advice within two years after developing symptoms. Fifty eight patients showed ophthalmopathy ranging from mild to moderate form with no case with severe ophthalmopathy. About 71 percent patients showing ophthalmopathy were hyperthyroid. The common ophthalmic signs were lid retraction, lid lag, exophthalmos and mild conjunctival congestion and chemosis. No case of extraocular muscle motility defect or optic nerve compression was found in this series of patients. Infiltrative dermatopathy, being a rare finding, was not observed in this study.Conclusion: Ophthalmopathy occur in about 50% of patients therefore ophthalmologist has an important roll in the diagnosis and management of this disease. These patients can be made comfortable by local and systemic therapy, radiation or surgical intervention while waiting for spontaneous remission of the disease process as none of these therapies can alter the natural course of Gravesʹ ophthalmopathy. After stabilization of disease strabismus surgery followed by lid surgery can correct diplopia and improve cosmesis.