Tariq Jalal, Zia ul Islam.
Ophthalmic manifestation of Graves disease.
J Postgrad Med Inst Jan ;17(2):199-207.

Objective: The purpose of this study is to find out various ophthalmic sign in patients with Graves` disease, their relative frequency and the percentage of patients severely affected resulting in loss of vision. Material arid Methods: This prospective study is based on finding ophthalmic signs in one hundred patients with established Graves` disease attending ophthalmic and medical units of Khyber Teaching Hospital Peshawar as well as Institute of Radiotherapy and Nuclear Medicine (IRNUM) Peshawar. The total duration of study is seventeen months i.e. from August 1994 to December 1995. Relation of thyroid hormone level to severity of ophthalmic signs and percentage of euthyroid patients with ophthalmopathy is also taken into consideration. Moreover unilateral and bilateral presentation is also compared. Results: A total of one hundred patients with Graves` disease were examined, over a period of seventeen months. These patients were examined thoroughly for possible ophthalmic signs. Eighty four patients were female and 16 patients were male. Family history was positive in 32 percent of patients. Association between smoking habit and ophthalmopathy could not be established. Their mean age was 45 years (age range 15-60 years). Usually the patients with Graves` disease sought medical advice within two years after developing symptoms. Fifty eight patients showed ophthalmopathy ranging from mild to moderate form with no case with severe ophthalmopathy. About 71 percent patients showing ophthalmopathy were hyperthyroid. The common ophthalmic signs were lid retraction, lid lag, exophthalmos and mild conjunctival congestion and chemosis. No case of extraocular muscle motility defect or optic nerve compression was found in this series of patients. Infiltrative dermatopathy, being a rare finding, was not observed in this study. Conclusion: Ophthalmopathy occur in about 50% of patients therefore ophthalmologist has an important roll in the diagnosis and management of this disease.

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