J Korean Ophthalmol Soc.  2008 Aug;49(8):1350-1355. 10.3341/jkos.2008.49.8.1350.

A Case of Remarkable Variation of Strabismic Angle in Thyroid Ophthalmopathy

• Lee YH
• Wang SJ
• Hwang JM

• KMID: 2211744
• DOI: http://doi.org/10.3341/jkos.2008.49.8.1350

Abstract

PURPOSE
We report a patient with strabismus associated with thyroid ophthalmopathy whose condition changed remarkably for 6 years of a natural course.
CASE SUMMARY
A 69-year-old woman with Graves' disease presented with diplopia in April 1999. On examination, she showed left hypotropia of 50 prism diopters (Delta) accompanied by supraduction limitation and lid lag in the left eye. She was diagnosed with strabismus associated with thyroid ophthalmopathy and was observed without any intervention. In October 2000, her left hypotropia decreased to 16Delta, and esotropia of 14Delta developed. Both eyes showed limitation of supraduction, and the left eye showed limitation of abduction. In December 2003, the esotropia increased to 35Delta, and the direction of vertical strabismus changed to 40Delta of right hypotropia. Supraduction limitation of the right eye and abduction restriction of both eyes increased, and infraduction limitation of the left eye developed. In April 2005, esotropia increased to 75Delta, and the amount of right hypotropia was 35Delta. The abduction limitation of both eyes increased.
CONCLUSION
The natural course of strabismus associated with thyroid ophthalmopathy can show continuous and remarkable changes.

Keyword

Strabismus; Thyroid ophthalmopathy

MeSH Terms

Aged
Diplopia
Esotropia
Eye
Female
Graves Disease
Humans
Strabismus
Thyroid Gland

Figure

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  Figure 1. Photographs of 9-cardinal positions in April 1999 showed a limitation of supraduction (-4) of the left eye, and 50 prism diopters of left hypotropia in the primary position.

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  Figure 2. Photographs of 9-cardinal positions in October 2000 showed limitation of supraduction (-4) in both eyes, and abduction limitation of -1/2 in the left eye. Esotropia of 14 prism diopters occurred, and left hypotropia decreased to 16 prism diopters.

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  Figure 3. Photographs of 9-cardinal positions in December 2003 showed increased supraduction limitation in the right eye, and showed limitation (-1) of infraduction and abduction in the left eye. Esotropia increased to 35 prism diopters and direction of vertical deviation changed to right hypotropia of 40 prism diopters.

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  Figure 4. Photographs of 9-cardinal positions in April 2005 showed no significant change in limitation of vertical movement. But limitation of abduction increased to -1 in the right eye, and -3 in the left eye. Esotropia increased to 75 prism diopters, but the amount of right hypotropia did not change significantly.

Reference

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