Eyeball position in Graves orbitopathy and its significance for eyelid surgery. 1998

W A van den Bosch, and M J Tjon-Fo-Sang, and H G Lemij
Department of Oculoplastic Surgery, Rotterdam Eye Hospital, The Netherlands.

The goal of this article is to investigate the effect of Graves orbitopathy and orbital decompression on the position of the eyeball, and to relate this to a straight upper eyelid contour, observed in several patients after correction of upper eyelid retraction. The positions of the pupil center and the upper and lower eyelid margin were measured in relation to a reference line through the medial canthi, on slides obtained from 120 eyelids before and after correction of upper eyelid retraction, and on similar slides obtained from 90 control eyelids. In control subjects, the distance between the reference line and the pupil center was, on average, 4.5 mm (SD 1.2 mm). In decompressed patients, the pupil center was, on average, 2.2 mm lower (SD 1.3 mm), and in nondecompressed patients it was, on average 1.0 mm lower (SD 1.2 mm). A relatively straight upper eyelid contour after otherwise satisfactory correction of upper eyelid retraction was observed in 14 eyelids of 8 patients. All cases occurred in decompressed patients with a distance between the pupil center and the reference line of 2 mm or less. No significant difference was found in the position of the lateral canthal angle between the three groups. Many patients with Graves orbitopathy show a downward shift of the pupil center in relation to a reference line through the medial canthi. This is partially caused by orbital decompression, but also by other factors discussed by the authors. If the distance between this reference line and the pupil center is 2 mm or less, otherwise satisfactory correction of upper eyelid retraction may cause visible straightening of the upper eyelid contour.

UI MeSH Term Description Entries
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D009915 Orbit Bony cavity that holds the eyeball and its associated tissues and appendages. Eye Socket,Eye Sockets,Orbits,Socket, Eye,Sockets, Eye
D011680 Pupil The aperture in the iris through which light passes. Pupils
D005094 Exophthalmos Abnormal protrusion of both eyes; may be caused by endocrine gland malfunction, malignancy, injury, or paralysis of the extrinsic muscles of the eye. Proptosis,Proptoses
D005141 Eyelid Diseases Diseases involving the EYELIDS. Disease, Eyelid,Diseases, Eyelid,Eyelid Disease
D005143 Eyelids Each of the upper and lower folds of SKIN which cover the EYE when closed. Eyelid
D006111 Graves Disease A common form of hyperthyroidism with a diffuse hyperplastic GOITER. It is an autoimmune disorder that produces antibodies against the THYROID STIMULATING HORMONE RECEPTOR. These autoantibodies activate the TSH receptor, thereby stimulating the THYROID GLAND and hypersecretion of THYROID HORMONES. These autoantibodies can also affect the eyes (GRAVES OPHTHALMOPATHY) and the skin (Graves dermopathy). Basedow's Disease,Exophthalmic Goiter,Goiter, Exophthalmic,Graves' Disease,Basedow Disease,Hyperthyroidism, Autoimmune,Basedows Disease,Disease, Basedow,Disease, Basedow's,Disease, Graves,Disease, Graves',Exophthalmic Goiters,Goiters, Exophthalmic
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly

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