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Exophthalmos (also called exophthalmus, exophthalmia, proptosis, or exorbitism) is a bulging of the eye anteriorly out of the orbit. Exophthalmos can be either bilateral (as is often seen in Graves' disease ) or unilateral (as is often seen in an orbital tumor).
In medical literature, Anglo-Irish surgeon Robert James Graves, in 1835, was the first to describe the association of a thyroid goitre with exophthalmos (proptosis) of the eye. [29] Graves' ophthalmopathy may occur before, with, or after the onset of overt thyroid disease and usually has a slow onset over many months. [citation needed]
The diagnosis may be suspected based on symptoms and confirmed with blood tests and radioiodine uptake. [1] [4] Typically, blood tests show a raised T 3 and T 4, low TSH, increased radioiodine uptake in all areas of the thyroid, and TSI antibodies. [4] The three treatment options are radioiodine therapy, medications, and thyroid surgery. [1]
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 Karl Stellwag von Carion.
Abadie's sign of exophthalmic goiter is a medical sign characterized by spasm of the levator palpebrae superioris muscle with retraction of the upper lid (so that sclera is visible above cornea) seen in Graves-Basedow disease which, together with exophthalmos causes the bulging eyes appearance. [1] It is named for Jean Marie Charles Abadie. [2] [3]
Differential diagnosis Graves disease Joffroy's sign is a clinical sign in which there is a lack of wrinkling of the forehead when a patient looks up with the head bent forwards. [ 1 ]
Myxedema can also occur in the lower leg (pretibial myxedema) and behind the eyes (exophthalmos). [citation needed] Severe cases, requiring hospitalization can exhibit signs of hypothermia, hypoglycemia, hypotension, respiratory depression, and coma. [citation needed]
Chronic progressive external ophthalmoplegia (CPEO) is a type of eye disorder characterized by slowly progressive inability to move the eyes and eyebrows. [1] It is often the only feature of mitochondrial disease, in which case the term CPEO may be given as the diagnosis.