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EyeRounds.org: thyroid eye disease (Graves' ophthalmopathy)
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"University of Iowa
University of Iowa Hospitals and Clinics
UI Carver College of Medicine
UI Ophthalmology & Visual Sciences
EyeRounds.org
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Thyroid Eye Disease (Graves' ophthalmopathy):
51 year-old man seen in consultation from the internal medicine service for evaluation and management of “dry and red eyes.”
Susannah Quisling, M.D., Andrew G. Lee, M.D.
February 21, 2005
CC : The patient was a 51 year-old man seen in consultation from the internal medicine service for evaluation and management of “dry and red eyes.”
HPI : The patient has a history of hyperthyroidism which was diagnosed 2 years ago and had been managed medically until he developed agranulocytosis on tapazole and had other complications while on methimazole and propylthyiouracil . On presentation to the eye clinic, he was complaining of horizontal binocular diplopia on extreme up-gaze. He was not bothered by the diplopia. He had some complaints of blurry vision in the morning.
PMH/FH/POH : His ocular history was not significant as he had no prior history of ocular surgery, trauma, or ambylopia.
EXAM
Best corrected visual acuities: 20/30 OD and 20/20 OS.
Pupils: 0.9 LU RAPD OD.
Confrontational VF: full OU. See HVF below.
EOM: -2 underaction to elevation OD and -3 underaction to elevation OS (see photos).
IOP: normal OU
Anterior segment: lid retraction OU and lagophthalmos OU. There were corneal punctate epithelial erosions (PEE) inferiorly OU. There was injection over the medial rectus muscles OU.
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