Transantral orbital decompression in the treatment of Graves' disease.

A series of twenty patients operated on for severe endocrine exophthalmos is presented. All the operations were performed by removing the orbital floor, making a total ethmoidectomy and removing part of the inferior orbital margin; in some cases, a section of the lateral orbital wall was also removed. No serious complications were detected. In all but one patient there was an immediate, marked decrease in exophthalmometry. A marked decrease of the inflammatory signs of the conjunctivae was also observed within a week following surgery.

Orbital decompression in endocrine exophthalmos of Graves' disease.

Transantral decompression was performed bilaterally in 27 and unilaterally in 3 patients with endocrine exophthalmos of Graves' disease. In 28 patients there was an immediate reduction of proptosis and in about half of the patients in addition a marked decrease in chemosis and conjunctival injection indicating that these signs were mostly due to orbital vascular congestion. In one patient with exophthalmos of more than 2 years duration and progressive swelling of the eye muscles no response was observed. In another patient decompression did not reduce proptosis which, however, 4 months later responded to retrobulbar irradiation. In one further patient much more marked reduction of proptosis and disappearance of persistent periorbital swellings were obtained after glucocorticoid treatment given half a year after decompression. Postoperatively diplopia occurred in about half of the patients but corrective operations were required only in a quarter of the patients. Transantral decompression is an effective method for rapid treatment of progressive exophthalmos of Graves' disease. In patients with unilateral exophthalmos the asymmetry may be reversed after unilateral operation. The authors use decompression not only in the most severe cases (categories 5 and 6a-c according to the classification of the American Thyroid Association) but also in less severe cases (categories 2b-c and 3b-c) when there is a steady progression as a primary treatment possibly combined with other forms of therapy.

Incidence of loss of vision in the healthy eye in amblyopia.

In Finland during the 20-year period 1958-78 35 patients with amblyopia lost the vision of the healthy eye. In more than 50% the cause was traumatic. The incidence of the loss of the healthy eye was 1.75 +/- 0.30 per thousand. During the same period in Finland the overall blindness rate of children was 0.11 per thousand and of adults aged 15-64 years 0.66 per thousand. For the amblyopic patient the risk of becoming blind is markedly higher than for the general population.

A clinical study on the detection of strabismus, anisometropia or ametropia of children by simultaneous photography of the corneal and the fundus reflexes.

Twenty two strabismus and 106 straight eyed patients with anatomically normal eyes were first photographed with a conventional camera equipped with a weak 100 mm teleobjective and coaxial flashlight and then examined clinically. The possibility of detecting strabismus, anisometropias and ametropias in the photographs by noting the localisation of the corneal reflexes and examining the appearance and lightness of the fundus reflexes and their possible asymmetry were tested in a double blind study. Even small angled strabismus cases could be found because of the asymmetrical localisation of the corneal reflexes. In 18 of the 22 strabismus cases (82%) there was asymmetrical lightness of the fundus reflexes and the fundus reflex of the deviating eye was lighter than that of the fixating eye. All the straight eyed anisometropias of 3.0 diopters or more (five cases) were observed in the photographs because of the asymmetrical appearance of the fundus reflexes. In straight eyed anisometropias of under 3.0 diopters, the fundus reflexes were symmetrical in 90 cases and asymmetrical in 11 cases (11%). Only three out of eight hyperopias of fomr +4.5 to +6.0 diopters were found because of the light crescent in the low part of the pupil. All myopias of over -4.0 diopters (14 cases) were observed because of the light crescent appearance in the upper part of the pupil. No pupillary crescents appeared with refractions of less than -1.75 diopters myopia or less than +4.5 diopters hyperopia; 172 eyes came within this range. Even a technician can perform, without premedication, the method tested here for rapid and simple screening to detect strabismus and straight eyed anisometropias of 3.0 diopters or more in small children or other patients who do not co-operate well in normal clinical examination. Over -4.0 diopters myopias can also be found. The method was rather unreliable for finding hyperopias, presumably because no cycloplegic drops were used.