ABSTRACT
Vertical palpebral fissure determinants and lid crease height were measured in patients with Graves' eye disease (GED) and in normal subjects. The fissure and crease height are positively correlated with exophthalmometer readings in each group. Compensatory levator aponeurosis defects are shown to occur in patients with GED. These, along with the effect of exophthalmos on the lower lid position, the observation that the lower lid is closer to the inferior limbus than the upper lid is to the superior limbus in normal subjects, and the effect of contracture of the inferior rectus on the lower lid position, explain why inferior scleral show is found to be greater than superior scleral show in patients with GED. Thus, lid retractor surgery in GED patients should be performed only after the palpebral fissure, levator function, and lid crease height stabilize, and after any contemplated surgery that would alter the exophthalmos and extraocular muscles has been performed.
Subject(s)
Exophthalmos/complications , Eyelids/physiopathology , Graves Disease/complications , Muscles/physiopathology , Tendons/physiopathology , Adolescent , Adult , Aged , Exophthalmos/pathology , Exophthalmos/physiopathology , Eyelids/pathology , Female , Humans , Male , Middle Aged , Sclera/pathologyABSTRACT
The levator function and exophthalmometer reading were measured on each side of 81 patients with Graves' eye disease (GED) and 111 normal subjects. There was a significant positive correlation between the levator function and exophthalmometer reading for both GED patients and normal subjects. This indicates that the forward position of the eye chronically stretches the levator muscle by the addition of sarcomeres which increases the range of movement of the lid. The range of movement may be decreased in patients with Graves' eye disease, from inflammation, such as is seen with other extraocular muscles. This effect is most likely to be marked in the patient with compressive optic neuropathy.
Subject(s)
Graves Disease/physiopathology , Oculomotor Muscles/physiopathology , Adult , Eyelids/physiopathology , Female , Humans , Male , Middle Aged , Optic Nerve Diseases/physiopathology , PressureABSTRACT
Exophthalmometer readings were measured in 84 patients with Graves' eye disease (GED) and 111 normal subjects. The mean exophthalmometer reading was significantly greater in patients with GED than in normal subjects. Asymmetry of the orbital disease produced less correlation of the exophthalmometer readings between right and left eyes of GED patients than is found in normal subjects. Expected gender and age effects on the exophthalmometer reading were not found among the GED patients. The mean exophthalmometer reading was not significantly higher for GED patients with compressive optic neuropathy than in the other subgroups of GED patients, suggesting that exophthalmos per se is not harmful to the optic nerve.
Subject(s)
Graves Disease/pathology , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Nerve Compression Syndromes/pathology , Optic Nerve Diseases/pathology , Orbit/pathology , Sex FactorsABSTRACT
Thirty-three patients with Graves' eye disease (GED) and 68 normal subjects had their orbital compliance measured by determining the force generated on retropulsing the eye and also estimated on digital retropulsion, and their eye position determined with an exophthalmometer. Patients with compressive optic neuropathy showed significantly higher mean forward force on retropulsion than other Graves' eye disease patients or normal subjects, supporting the theory that the tissue is compressed in these orbits. There is a suggestion that orbital compliance testing of a GED patient without compressive optic neuropathy may be of value in predicting the risk of the patient developing compressive optic neuropathy. There is no association between the force on ocular retropulsion and the exophthalmometer reading. The digital estimation of the resistance to retropulsion did not reliably suggest the measured forces.
