USMLE Internal Medicine Review 12 09 Ophthalmyopathy

USMLE Internal Medicine Review 12 09 Ophthalmyopathy

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Play USMLE Audio MP3 12 09 Ophthalmyopathy Below

 

Begin 12 09 Ophthalmyopathy Transcription

Ophthalmopathy is often seen as a complication of Graves’ disease. Opinions vary but one line of thinking is that only total thyroidectomy or total ablation of the thyroid with radioiodine will prevent recurrence of thyrotoxicosis which can reactivate residual ophthalmopathy.

What is a far more conservative measure to reduce the periorbital edema of ophthalmopathy?

  • Elevating the head at bedtime reduces periorbital edema.

For severe acute inflammatory reaction in ophthalmopathy, a short course of corticosteroid therapy is often effective. Particularly which agent and dose?

  • Prednisone 100mg po qd in divided doses for 7-14 days then gradually reducing over 6-12 weeks.

If corticosteroid therapy is ineffective which imaging technique may be helpful for severe eye inflammation with Graves’ disease?

  • External x-ray therapy to the retro-bulbular area.

And which 2 eye structures need to be shielded during external x-ray?

  • The lens and the anterior chamber.

What is the treatment technique that can be used in very severe cases of ophthalmopathy where vision is threatened? 

  • Orbital decompression.

There are 2 types of orbital decompression procedures. Transantral and anterior approaches. What is the route of entry in the transantral approach? Pause the tape for this.

  • The transantral approach for orbital decompression enters through the maxillary sinus. The floor and lateral walls of the orbit are removed.

And what is the route of entry in the anterior approach?

  • In the anterior approach to orbital decompression, entry is under the globe. Also with portions of the orbital floor and walls removed.

Both orbital decompression approaches have been very effective techniques, with exophthalmos reduced by as much as 5-7mm in each eye. After the acute process have subsided the patient is often left with either of which 2 eye abnormalities due to muscle fibrosis and contracture. The orbital decompression patient if often left with double vision or lid abnormalities.

How can these be corrected?

  • By eye muscle or cosmetic lid surgery.

Student doctor please pause the tape and summarize for ophthalmopathy as a complication of Graves’ disease. Please include prevention measures, head elevation, corticosteroid use, external x-ray and orbital decompression.

  • Ophthalmopathy is often seen as a complication of Graves’ disease. Opinions vary but one line of thinking is that only total thyroidectomy or total ablation of the thyroid with radioiodine will prevent recurrence of thyrotoxicosis which can reactivate residual ophthalmopathy. A conservative measure to reduce the periorbital edema of ophthalmopathy is elevating the head at bedtime. For severe acute inflammatory reaction in ophthalmopathy, a short course of corticosteroid therapy is often effective. Especially prednisone 100mg po qd in divided doses for 7-14 days then gradually reducing over 6-12 weeks. If corticosteroid therapy is ineffective, external x-ray therapy to the retrobulbular area may be helpful for severe eye inflammation with Graves’ disease. During external x-ray, the lens and the anterior chamber need to be shielded. Orbital decompression is the treatment technique that can be used in very severe cases of ophthalmopathy where vision is threatened. The 2 types of orbital decompression procedures are transantral, in which entry is through the maxillary sinus with the floor and lateral walls of the orbit removed, and the anterior approach, in which entry is under the globe, also with portions of the floor and walls removed. Both orbital decompression approaches have been very effective with exophthalmos reduced by as much as 5-7mm of each eye. After the acute process have subsided the orbital decompression patient is often left with double vision or lid abnormalities due to muscle fibrosis and contracture. These can be corrected by eye muscle or cosmetic lid surgery.

****END OF TRANSCRIPTION****

 

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