Thyroid Eye Disease
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Thyroid Eye Disease
Graves’ ophthalmopathy, also known as thyroid eye disease (TED), is an autoimmune inflammatory disorder of the orbit and periorbital tissues, characterized by upper eyelid retraction, lid lag, swelling, redness (erythema), conjunctivitis, and bulging eyes (exophthalmos). It occurs most commonly in individuals with Graves' disease, and less commonly in individuals with Hashimoto's thyroiditis, or in those who are euthyroid. It is part of a systemic process with variable expression in the eyes, thyroid, and skin, caused by autoantibodies that bind to tissues in those organs. The autoantibodies target the fibroblasts in the eye muscles, and those fibroblasts can differentiate into fat cells (adipocytes). Fat cells and muscles expand and become inflamed. Veins become compressed and are unable to drain fluid, causing edema. Annual incidence is 16/100,000 in women, 3/100,000 in men. About 3–5% have severe disease with intense pain, and sight-threatening corneal ulceration or com ...
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Autoimmune
In immunology, autoimmunity is the system of immune responses of an organism against its own healthy cells, tissues and other normal body constituents. Any disease resulting from this type of immune response is termed an "autoimmune disease". Prominent examples include celiac disease, post-infectious IBS, diabetes mellitus type 1, Henoch–Schönlein purpura (HSP) sarcoidosis, systemic lupus erythematosus (SLE), Sjögren syndrome, eosinophilic granulomatosis with polyangiitis, Hashimoto's thyroiditis, Graves' disease, idiopathic thrombocytopenic purpura, Addison's disease, rheumatoid arthritis (RA), ankylosing spondylitis, polymyositis (PM), dermatomyositis (DM), Alopecia Areata and multiple sclerosis (MS). Autoimmune diseases are very often treated with steroids. Autoimmunity means presence of antibodies or T cells that react with self-protein and is present in all individuals, even in normal health state. It causes autoimmune diseases if self-reactivity can lead to tissue ...
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Anakinra
Anakinra, sold under the brand name Kineret, is a biopharmaceutical medication used to treat rheumatoid arthritis, cryopyrin-associated periodic syndromes, familial Mediterranean fever, and Still's disease. It is a recombinant and slightly modified version of the human interleukin 1 receptor antagonist protein. It is marketed by Swedish Orphan Biovitrum. Anakinra is administered by subcutaneous injection. Medical uses It is used as a second line treatment to manage symptoms of rheumatoid arthritis after treatment with a disease-modifying antirheumatic drug (DMARD) has failed. It can be used in combination with some DMARDs. It is used to people with a cryopyrin-associated periodic syndrome, including neonatal-onset multisystem inflammatory disease. It is used to treat Schnitzler's syndrome (off label in the US). Its response rate is such that it has been suggested that "Treatment failures should lead to reconsider the diagnosis." Off label, it is used to treat systemic juven ...
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Non-specific Symptom
Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than normal, raised or lowered blood pressure or an abnormality showing on a medical scan. A symptom is something out of the ordinary that is experienced by an individual such as feeling feverish, a headache or other pain or pains in the body. Signs and symptoms Signs A medical sign is an objective observable indication of a disease, injury, or abnormal physiological state that may be detected during a physical examination, examining the patient history, or diagnostic procedure. These signs are visible or otherwise detectable such as a rash or bruise. Medical signs, along with symptoms, assist in formulating diagnostic hypothesis. Examples of signs include elevated blood pressure, nail clubbing of the fingernails or toenails, staggering gait, and arcus senilis and arcus juvenilis of the eyes. Indicati ...
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Superior Limbic Keratoconjunctivitis
Superior limbic keratoconjunctivitis (SLK, Théodore's syndrome) is a disease of the eye characterized by episodes of recurrent inflammation of the superior cornea and limbus, as well as of the superior tarsal and bulbar conjunctiva. It was first described by F. H. Théodore in 1963. Symptoms and signs Patients present with red eye, burning, tearing, foreign body sensation and mild photophobia. Upon examination, the conjunctiva appears inflamed and thickened, especially at the limbus. Pathophysiology The development and pathophysiology of SLK is not well understood, but appears to involve microtrauma of keratoconjunctival surfaces. This mechanical hypothesis is supported by the increased lid apposition of exophthalmic thyroid patients, who are known to have an increased incidence of superior limbic keratoconjunctivitis. Diagnosis Treatment First-line treatments include topical corticosteroids and artificial tears. For non-responsive cases, potential treatments include top ...
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Punctate Epithelial Erosions
Punctate epithelial erosions are a pathology affecting the cornea. Signs and symptoms It is a characterized by a breakdown or damage of the epithelium of the cornea in a pinpoint pattern, which can be seen with examination with a slit-lamp. Patients may present with non-specific symptoms such as red eye, tearing, foreign body sensation, photophobia and burning. Cause Punctate epithelial erosions may be seen with different disorders: *Rosacea * Dry-eye syndrome *Blepharitis * Acute bacterial conjunctivitis *Trauma *Exposure keratopathy from poor eyelide closure *Ultraviolet or chemical burn *Contact lens-related disorder such as toxicity or tight lens syndrome *Trichiasis *Entropion or ectropion *Floppy eyelid syndrome *Chemotherapy i.e. cytosine arabinoside *Thygeson's Superficial Punctate Keratopathy Diagnosis Slit lamp examination Treatment Due to the different underlying causes, proper diagnosis, treatment, and prognosis can only be determined by an eye care profess ...
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Chemosis
Chemosis is the swelling (or edema) of the conjunctiva. The term derives from the Greek ''chem-'' meaning chemical and ''-osis'' meaning denoting action. A chemical reaction, or in this case, a chemical reaction of the conjunctiva which is due to the oozing of exudate from abnormally permeable capillaries. In general, chemosis is a nonspecific sign of eye irritation. The outer surface covering appears to have fluid in it. The conjunctiva becomes swollen and gelatinous in appearance. Often, the eye area swells so much that the eyes become difficult or impossible to close fully. Sometimes, it may also appear as if the eyeball has moved slightly backwards from the white part of the eye due to the fluid filled in the conjunctiva all over the eyes except the iris. The iris is not covered by this fluid and so it appears to be moved slightly inwards. Causes It is usually caused by allergies or viral infections, often inciting excessive eye rubbing. Chemosis is also included in the C ...
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Stellwag's Sign
Stellwag's sign is a sign of infrequent or incomplete blinking associated with exophthalmos or Graves orbitopathy. It is accompanied by Dalrymple's sign, which is a retraction of the upper eyelids resulting in an apparent widening of the palpebral opening. Stellwag's sign is named after Austrian ophthalmologist Ophthalmology ( ) is a surgery, surgical subspecialty within medicine that deals with the diagnosis and treatment of eye disorders. An ophthalmologist is a physician who undergoes subspecialty training in medical and surgical eye care. Followin ... Karl Stellwag von Carion. References Definition at Dorlands Medical Dictionary Eye Symptoms and signs: Endocrinology, nutrition, and metabolism {{Eponymous medical signs for eyes and ears ...
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Lagophthalmos
Lagophthalmos is the inability to close the eyelids completely. Cline D; Hofstetter HW; Griffin JR. ''Dictionary of Visual Science''. 4th ed. Butterworth-Heinemann, Boston 1997. Blinking covers the eye with a thin layer of tear fluid, thereby promoting a moist environment necessary for the cells of the exterior part of the eye. The tears also flush out foreign bodies and wash them away. This is crucial to maintain lubrication and proper eye health. If this process is impaired, as in lagophthalmos, the eye can suffer abrasions and infections. Lagopthalmos leads to corneal drying and ulceration. Type(s) Nocturnal lagophthalmos is the inability to close the eyelids during sleep. It may reduce the quality of sleep, cause exposure-related symptoms or, if severe, cause corneal damage (exposure keratopathy). The degree of lagophthalmos can be minor (obscure lagophthalmos) or quite obvious. It is often caused by an anomaly of the eyelid that prevents full closure. Treatment may involve ...
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Dalrymple's Sign
Dalrymple's sign is a widened palpebral (eyelid) opening, or eyelid spasm, seen in thyrotoxicosis (as seen in Graves' disease, exophthalmic goitre and other hyperthyroid conditions), causing abnormal wideness of the palpebral fissure. As a result of the retraction of the upper eyelid, the white of the sclera is visible at the upper margin of the cornea in direct outward stare.Cline D; Hofstetter HW; Griffin JR. ''Dictionary of Visual Science''. 4th ed. Butterworth-Heinemann, Boston 1997. It is named after British ophthalmologist, John Dalrymple (1803–1852). Other eye signs described within the symptomology of Graves' disease are Stellwag's sign (rare blinking), Rosenbach's sign (tremor of the eyelids), and Jelink's sign (hyperpigmentation of the eyelid). See also *Graves ophthalmopathy Graves’ ophthalmopathy, also known as thyroid eye disease (TED), is an autoimmune inflammatory disorder of the orbit and periorbital tissues, characterized by upper eyelid retraction, lid l ...
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Palpebral Fissure
The palpebral fissure is the elliptic space between the medial and lateral canthi of the two open eyelids. In simple terms, it is the opening between the eyelids. In adult humans, this measures about 10 mm vertically and 30 mm horizontally. Variations Congenital dysmorphisms It can be reduced (short, "narrow") in horizontal size by fetal alcohol syndrome and in Williams syndrome. The chromosomal conditions trisomy 9 and trisomy 21 (Down syndrome) can cause the palpebral fissures to be upslanted, whereas Marfan syndrome can cause a downslant. An increase in vertical height can be seen in genetic disorders such as cri-du-chat syndrome. Acquired The fissure may be increased in vertical height in Graves' disease, which is manifested as Dalrymple's sign. It is seen in disorders such as cri-du-chat syndrome. In animal studies using four times the therapeutic concentration of the ophthalmic solution latanoprost, the size of the palpebral fissure can be increased. The condition ...
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Kocher's Sign
Kocher's sign is a medical sign that denotes an eyelid phenomenon in hyperthyroidism and Basedow's disease. In fixation on a fast upwards movement there occurs a convulsive retraction of the eyelid. References

Endocrinology {{Med-sign-stub ...
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Von Graefe's Sign
Von Graefe's sign is the lagging of the upper eyelid on downward rotation of the human eye, eye, indicating exophthalmos, exophthalmic Goitre, goiter (Graves' disease).Cline D; Hofstetter HW; Griffin JR. ''Dictionary of Visual Science''. 4th ed. Butterworth-Heinemann, Boston 1997. It is a dynamic sign, whereas lid lag is a static sign which may also be present in cicatricial eyelid retraction or congenital ptosis. A pseudo Graefe's sign (pseudo lid lag) shows a similar lag, but is due to aberrant regeneration of fibres of the oculomotor nerve (III) into the elevator of the upper lid. It occurs in paramyotonia congenita. A pseudo Graefe's sign is most commonly manifested in just one eye but can occasionally be observed in both. The reason only one eye is affected is not yet clear. See also *Albrecht von Gräfe *Boston's sign *Griffith's sign *Graves orbitopathy *Hyperthyroidism, as lid lag may be in hyperthyroid patients lacking Graves' disease. References

Ophthalmology S ...
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