Guest guest Posted October 28, 2003 Report Share Posted October 28, 2003 Carol, This article was posted by Sami on Mediboard yesterday: Severe Graves' Ophthalmopathy After Retrobulbar Anesthesia for Cataract Extraction in a Patient With Mild Stable Thyroid Eye Disease Posted 10/17/2003 Chun-Hang Wai, Su-Chin Ho, Lay-Leng Seah, Kee-Siew Fong, Daphne Hsu-Chin Khoo Abstract and Introduction Abstract It has been hypothesized that the distinct anatomic localization of the Graves' triad may be partially explained by pressure and trauma. While there are reports of local trauma clearly contributing to the pathogenesis of pretibial myxedema, direct evidence for a similar mechanism in Graves' ophthalmopathy (GO) has been lacking. We describe a 65-year-old male patient with stable mild Graves' ophthalmopathy of 24 years' duration in whom a retrobulbar block was administered prior to cataract removal. Three weeks after the procedure, he complained of rapidly progressive bilateral diplopia. In 6 months, there was moderate exophthalmos, exposure keratitis, almost complete ophthalmoplegia, and decreasing visual acuity requiring surgical decompression. Postdecompression, inflammatory signs and vision improved but there was complete ophthalmoplegia. The eye signs remained unchanged for the next 4 months but there was exacerbation of the disease within a week of receiving radioiodine despite concomitant steroid administration. Orbital irradiation was finally administered with rapid improvement in extraocular eye muscle function. We hypothesize that local inflammatory and immune responses stimulated by trauma and/or pressure in the retrobulbar compartment, triggered the development of severe ophthalmopathy in this patient. Thyroid-stimulating immunoglobulin (TSI) levels remained markedly elevated despite the clinical improvement suggesting that the beneficial effects of radiotherapy in this case were not mediated by suppressing TSI production. Introduction The pathogenesis of Graves' ophthalmopathy (GO) remains an area of controversy. Autoimmune reactions directed against one or more shared antigens located in the thyroid and orbit are hypothesized to be the cause. While thyroglobulin[1] has recently been detected in the eye, current evidence favors the thyrotropin receptor (TSH-R) as the autoantigen.[2,3] Although it appears that environmental factors as well as systemic immune responses may contribute to GO, the fact that the disease is not infrequently unilateral suggests that local factors are also likely to play a role. We report a patient with mild thyroid eye disease who developed a severe, atypical form of GO after retrobulbar anesthesia for cataract surgery. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 28, 2003 Report Share Posted October 28, 2003 Carol, " I'm wondering of people with Graves are candidates for Lasik (or RK or any corrective eye surgery). " Elaine is the best person to answer this, but my ophtho told me last Monday that any indication of active disease (TED or other autoimmune thyroid disease) was a strong reason to avoid surgery on or around the eye. Sheila Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 28, 2003 Report Share Posted October 28, 2003 Carol, Do you have eye symptoms? That might make or break it. At 02:07 PM 10/28/2003, you wrote: >'s question about getting a tattoo left me wondering about >something. (No plans for a tatoo over here.) > >My Christmas present this year is supposed to be Lasik surgery. With all >this talk about TED, I'm wondering of people with Graves are candidates >for Lasik (or RK or any corrective eye surgery). I'll certainly ask at >the clinic when I go for my initial visit, but now I'm wondering if I need >to even keep that appointment. > >Anyone know anything about this? > >Carol Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 28, 2003 Report Share Posted October 28, 2003 <sigh> I don't really know. There was some orbital pressure last week, but it went away immediately after I started beta blockers. My lids are a bit heavy and seem to be sagging a bit. Otherwise, I think my eyes are fine. To lasik or not to lasik may be a question for an ophthalmologist, huh? Carol Re: Another question Carol, Do you have eye symptoms? That might make or break it. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 28, 2003 Report Share Posted October 28, 2003 Hmmm....Definitely something to think about. Thanks, . Carol Re: Another question Carol, This article was posted by Sami on Mediboard yesterday: Severe Graves' Ophthalmopathy After Retrobulbar Anesthesia for Cataract Extraction in a Patient With Mild Stable Thyroid Eye Disease Posted 10/17/2003 Chun-Hang Wai, Su-Chin Ho, Lay-Leng Seah, Kee-Siew Fong, Daphne Hsu-Chin Khoo Abstract and Introduction Abstract It has been hypothesized that the distinct anatomic localization of the Graves' triad may be partially explained by pressure and trauma. While there are reports of local trauma clearly contributing to the pathogenesis of pretibial myxedema, direct evidence for a similar mechanism in Graves' ophthalmopathy (GO) has been lacking. We describe a 65-year-old male patient with stable mild Graves' ophthalmopathy of 24 years' duration in whom a retrobulbar block was administered prior to cataract removal. Three weeks after the procedure, he complained of rapidly progressive bilateral diplopia. In 6 months, there was moderate exophthalmos, exposure keratitis, almost complete ophthalmoplegia, and decreasing visual acuity requiring surgical decompression. Postdecompression, inflammatory signs and vision improved but there was complete ophthalmoplegia. The eye signs remained unchanged for the next 4 months but there was exacerbation of the disease within a week of receiving radioiodine despite concomitant steroid administration. Orbital irradiation was finally administered with rapid improvement in extraocular eye muscle function. We hypothesize that local inflammatory and immune responses stimulated by trauma and/or pressure in the retrobulbar compartment, triggered the development of severe ophthalmopathy in this patient. Thyroid-stimulating immunoglobulin (TSI) levels remained markedly elevated despite the clinical improvement suggesting that the beneficial effects of radiotherapy in this case were not mediated by suppressing TSI production. Introduction The pathogenesis of Graves' ophthalmopathy (GO) remains an area of controversy. Autoimmune reactions directed against one or more shared antigens located in the thyroid and orbit are hypothesized to be the cause. While thyroglobulin[1] has recently been detected in the eye, current evidence favors the thyrotropin receptor (TSH-R) as the autoantigen.[2,3] Although it appears that environmental factors as well as systemic immune responses may contribute to GO, the fact that the disease is not infrequently unilateral suggests that local factors are also likely to play a role. We report a patient with mild thyroid eye disease who developed a severe, atypical form of GO after retrobulbar anesthesia for cataract surgery. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 28, 2003 Report Share Posted October 28, 2003 Yes, about asking the optho. You will really want to ask a very experienced surgeon, one who has done thousands of procedures. Your eye symptoms sound vague, but they should give you a good sense of what's appropriate. I had lasik done 1 1/2 years ago, and I am very pleased, tho I need a slight adjustment (they have this new wave technology that just got FDA approval which supposedly can fix a slight distortion in my cornea). I will soon be looking into that procedure. At 06:13 PM 10/28/2003, you wrote: ><sigh> I don't really know. There was some orbital pressure last week, >but it went away immediately after I started beta blockers. My lids are a >bit heavy and seem to be sagging a bit. Otherwise, I think my eyes are fine. > >To lasik or not to lasik may be a question for an ophthalmologist, huh? > >Carol > Re: Another question > > > Carol, > Do you have eye symptoms? That might make or break it. > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 23, 2008 Report Share Posted June 23, 2008 Seems all I do is ask questions. Here are 2 more: My son (9) had a really bad night the other night... crying, crying. Said he felt like a 'stick man' over and over. The next day when he was better and calmer I asked what he meant by that and he said that he felt like his arms and legs were made of sticks and if I touched them it felt like I might break them. Is this a familiar feeling to anyone... is this nerve pain, bone pain or ????? Second question... he has been experiencing an unusual growth spurt. He has been ill almost 12 months now....he shouldn't be growing like this, it's weird. Can sarcoid effect a part of his brain that could cause this? As always, thanks in advance for any info, Quote Link to comment Share on other sites More sharing options...
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