Thyroid associated orbithopathy

Abstract

Graves’ orbithopathy, frequently termed thyroid-associated orbitopathy an autoimmune disorder characterized by orbital inflammation involving both extra-ocular muscles and adipose tissue. Inappropriate immune reactions averse to the orbital antigens and damage of immune tolerance are probably involved in its pathogenesis. It is characterized by a wide open orbit appearance, caused by exophthalmus and upper eyelid retraction, occurs far more often in women than in men and is most prevalent between 30 and 60 years of age, however severe cases occur more often in men than in women. The ocular manifestations of thyroid-associated orbitopathy include also chemosis, proptosis, periorbital edema, as well as altered ocular motility with significant functional cosmetic or social consequences. The clinical manifestation may vary – from mild disease when it may be overlooked and misdiagnosed to severe irreversible sight-threatening complications. Although most cases of Graves’ orbithopathy do not result in visual loss, this disease can cause vision-threatening exposure keratopathy, troublesome diplopia or even compressive optic neuropathy. The present article summarize pathogenesis, clinical manifestations, and treatment of this so far poorly understood disorder, which is a problematic challenge to the ophthalmologist.