True statement about dysthyroid eye disease (grave's opthalmopathy) is: (A) Decreased power of divergence, (B) Most common cause of U/L proptosis in, (C) Extreme exopthalmos is usually seen in hypothyroidism, (D) On looking upwards lower lid does not follow eye movements
Answer is C. C. i.e. Extreme exopthalmos is usually seen in hypothyroidism A mild exopthalmos is associated with thyrotoxicosis and an extreme exopthalmos may be associated with any state of thyroid activity, but usually in hypothyroidism often after thyroidectomy.Q Dysthyroid / Graves-Opthalmopathy or Endocrine / Malignant-Exopthalmos * Etiology Clinical Features Treatment Autoimmune in General (Thyrotoxicosis) Ocular * GuanethidineQ may which there is * SymptomsQ * Dalrympe's Sign- decrease lid antibody - Tiredness Retraction of upper eye lid producing Staring retraction caused by mediated attack - Emotional lability & Frightened appearanceQ over.action of on orbital - Heat intolerance Mn-"D for Dar" muller's muscleQ fibroblast - Weight loss * Von Graefe's Sign- * Systemic Steroids & primarily, extraocular - Excessive appetite - Palpitation Lid lag i.e on looking downwardsQ (towards Ground) upperlid follows tardily or not at all Radiotherapy (if steroids not muscles being * SignsQ Mn-"Graefe-Lid lag on looking Ground" effective) 1000 rad secondarily - Tachycardia (persist during * Stellwag's Sign- from each lateral involvedQ sleep)Q Infrequent blinking with deficient closure of po for reducing * Pathology - Hot, moist palms lidsQ orbital edema Mononuclear cell - Agitation Mn-"S for Still" * Aificial tears & inflammation - Thyroid goiter & bruit * IVRibius Sign- Lateral with presence of - Myopathy of proximal Decreased power of convergenceQ tarsorrhaphy to mucopolysacchri muscles Mn- "M for On looking Medially" prevent exposure des * Stages of development of * Enroth's Sign- keratopathy predominantly cardiac arrhythmias Fullness of eylids d/1 puffy Edematous * Prismatic glasses for hyluronic acid - Tachycardia which persist swelling diplopia together with during sleep Mn- "E for Edematous lid" * Orbital Interstial edema (characteristic)Q * Gifford's Sign- decompression & inflamatory - Multiple extra systole Difficulty in eversion of upper lid When steroid & cells - Paroxysmal atrial * Exopthalmos (Proptosis) have proved tachycardia * Weakness of extraocular muscles paicularly ineffective two wall - Paroxysmal atrial elevators (inferior oblique)Q causing diplopia (orbital floor & fibrillation * Conjunctival injection over inseion of recti medial wall - Persistent atrial fibrillation * Increased intra ocular pressure removed) not responding to digoxin * Superior limbic keratopathy decompression is done 28) Grade 4 Extraocular muscle involvement Q (limitation of movement & diplopia) Grade 5 Corneal involvement (exposure keratitis) Grade 6 Loss of Sight (d/t optic nerve involvement with disc pallor or papilloedema & visual field defect) " v:shapes="_x0000_s1026">Graves opthalmopathy is most common cause of U/L or B/L proptosis in adults between age of 25-50 yearsQ Werner Classification reflect severity of opthalmopathy and is well known by acronym of NO SPECS. Grade 0 - No signs or symptoms Grade 1 - Only signs (lid retraction with or without lid lag Q & mild proptosis) Grade 2 - Soft tissue involvement (chemosis, grit, lacrimation, photophobia, lid or conjuctival swelling) Grade 3 Proptosis Q (minimal28) Grade 4 Extraocular muscle involvement Q (limitation of movement & diplopia) Grade 5 Corneal involvement (exposure keratitis) Grade 6 Loss of Sight (d/t optic nerve involvement with disc pallor or papilloedema & visual field defect)