[Therapeutic options in thyroid ophthalmopathy].

UNLABELLED: One of the most important features in Graves disease is thyroid myopathy. This condition accompanies the thyroid dysfunction, that can lead to hyper-, hypo- or euthyroidism. The thyroid myopathy is the most common cause of acquired double vision in adults. This paper analyzes the evolution of thyroid myopathy, after conservative and surgical treatment.

MATERIAL AND

METHODS

The clinical evolution in 15 patients with thyroid myopathy was analyzed. They have been treated conservatively with systemic corticosteroids. The orbital, local antiinflammatory treatment consisted in Rx antiinflammatory therapy and retrobulbar injections with corticosteroids. Three of the patients with restrictive strabismus and diplopia were operated on. In 2 of them, with malignant exophthalmia (proptosis), orbita decompression was necessary. The surgical strategy and timing in the restrictive strabismus is analyzed. In the follow up period, the extent of the proptosis (exophthalmometry), the extraocular muscle size (orbital ultrasound) and the diplopia (Hess-Lancaster test) were monitored. The clinical evolution in one patient treated conservatively and operated on is presented in detail.

DISCUSSIONS,

CONCLUSIONS

The conservative treatment of the thyroid myopathy is efficient only in the acute phase. The surgical treatment should be applied when muscular fibrosis and restrictive strabismus are present. The timing of surgery is indicated after 6 months of stable ocular deviation. Adjustable surgery is the most suitable procedure for the restrictive strabismus in thyroid myopathy.