1 Graves orbitopathy self study and qs

Question 1

Ocular complications of diseases with thyroid gland

Answer 1

Diseases of the thyroid gland can cause many ocular complications. The most common ones seen are proptosis, lid retraction, epiphoria, visual loss, lid lag, periorbital oedema, chemosis, strabismus (eso,hypo), AHP and in many cases it can lead to thyroid disease.

Question 2

What is the role of the orthoptist in the management of this condition?

Answer 2

The orthoptists role would be to perform a full orthoptic report to diagnose this condition. Then, when it comes to management the orthoptist would measure the exophthalmos ranges as this gives an induction as to the severity and if there is inflammation and how severe the proptosis is. If the patient has suspected thyroid problems the orthoptist would refer them to have blood work done. This would specifically look at TSH, TSI, anti thyroid antibodies, serum T3 and T4 index. The results will give help in the diagnosis as if the values are abnormal then this is conducive with a thyroid gland disease.

Question 3

Orhtoptic treatment of patients with GO

Answer 3

The orthoptist will be responsible for the diagnosis, assessment of VA, BSV, colour vision and documenting any changes in ocular movement. Also, as the patient will be seen regularly by the ophthalmologist and the orthoptist in clinic the orthoptists role is to record the disease progress and share this information with the clinician. In doing this the orthoptist can establish when ocular symptoms stabilise e.g. the prism dioptre where the diplopia is reduced. Another responsibility is picking up on symptoms that can be managed orthoptically e.g. diplopia and offering the appropriate treatment. The orthoptist must work alongside the ophthalmologist to plan long term management e.g. the appropriate surgery like orbital decompression or thyroidectomy and any appropriate medications which can manage the symptoms.

Question 4

Diplopia and GO

Answer 4

If the patient has persistent diplopia that is really bothering them the orthoptist can offer them prisms to eliminate this as best as possible. This will relieve one of their many ocular symptoms. Also, since the patient will be seen regularly, the prism strength can be increased as needed.

Question 5

Surgery and GO

Answer 5

Surgeries in GO is used for a few functions; sight saving, strabismus, restore lid, encouraging use of AHP. The most common surgery to manage graves orbitopathy is orbital decompression. This involves removing bone from the bones of the orbit to reduce eye petrusion. This has many benefits as it improves cosmesis and other sight threating conditions. A thyroidectomy can be performed for patients with graves orbitopathy with hyperthyroid. This involves removing most of the thyroid gland as it has been enlarged and stopping hormone production. It is usually done on younger patients as there is a better post op outcome and it is more manageable. The post-op recurrence is 10-15% in this surgery.

Question 6

If MR is affected the deviation and main restriction will be…

Answer 6

ESO
-limited ABD

Question 7

If the inferior rectus is affected, the deviation and main restriction will be?

Answer 7

HYPO
-limited elevation

Question 8

What would be appropriate for a patient with GO who has mod RHoT measuring 15 PD with -2 restriction of R elevation?

Answer 8

Botox and RSR

Question 9

Main signs of GO

Answer 9

Dry eye, lid odema, proptosis

Question 10

Most common treatments of hyperthyroidism

Answer 10

Drugs- Carbimazole
Radioactive iodine

Question 11

Why is the incidence of GO greater in women?

Answer 11

Menopause affect on hormones

Question 12

What equipment is used to measure exophthalmos?

Answer 12

exophthalmometer