TITLE:
Malignant Graves’ Ophthalmopathy
AUTHORS:
José Francisco de Salles Chagas, Jose Luis Braga de Aquino, Maria Beatriz Nogueira Paschoal, Luis Antonio Brandi Filho, Fernanda Fruet, Douglas Alexandre Rizzanti Pereira, Fernanda Garcia Callegari, Thalita dos Reis Ruba
KEYWORDS:
Malignant Exophthalmos; Ethmoidectomy; Hyperthyroidism
JOURNAL NAME:
International Journal of Otolaryngology and Head & Neck Surgery,
Vol.3 No.2,
March
10,
2014
ABSTRACT:
Introduction: One of the most common causes of
hyperthyroidism is Graves’ disease. The malignant exophthalmos is a rare condition characterized
by the loss of visual function that doesn’t adequately respond to various forms
of treatment, requiring, in most cases, surgical correction. Objective: We report
a case of conjunctival edema and protrusion of the eyeball in patients secondary to Graves’ disease, characterizing malignant
ophthalmopathy and discuss their surgical treatment. Case Report: A 73-year-old male patient presenting bilateral
conjunctive hyperaemia, decreased visual acuity, exophtalmos with progressive
deterioration. Pulse therapy was performed without improvement and then underwent bilateral
ethmoidectomy. Discussion: Late diagnosis is harmful due to the fact that malignant
disease is extremely aggressive and fast, as reported in this case. Most often, the ophthalmopathy
follows a relatively mild and self-limiting course, making a proper diagnosis difficult
if the disease progresses. In extreme cases acute orbital decompression is indicated complementing appropriate
medical treatment, which will allow herniation of orbital contents. Many orbital
decompression techniques have been used in the treatment of Graves’ ophthalmopathy.
The most common of these is the endoscopic sinus surgery which potentiated act in
decompression of the medial wall safely and minimally invasive. In our case, open
bilateral ethmoidectomy was used, due to the fact that surgeons are most experienced
in this technique. Although the post-operative has been successfully submitted,
no signs of recurrence were observed after fifteen days due to the
evolution of Graves’ disease. Even with outpatient treatment, he walked to the total visual
loss. Conclusion: We observed that the malignant ophthalmopathy is rare and aggressive; however, in spite of therapeutic resources used,
it can progress to total visual loss.