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M. Quiroz, C. Murillo, A. Moreno, L. Berganza, J. Vargas; Dysthyroid Strabismus: Ophtalmologic Findings in 150 Mexican Patients. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5266.
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To evaluate findings in our experience, by the records review of 150 patients with the diagnosis of autoimmune infiltrative orbitopathy. We study type and magnitude of deviation, movement limitation, diplopia, evolution time, surgery and presence or not of optic neuropathy, as well as muscular affection with orbit tomography. Autoimmune infiltrative orbitopathy is an inflammatory orbital disease that has an immunologic origin and most of the time is related to systemic disorders of the thyroid gland. The disease has a variable clinical presentation and it may cause severe damage in vision, ocular alignment and orbital architecture. The pathogenesis of the disease involves a common autoantigen shared between the thyroid gland and the orbital adipogenic fibroblasts. Women are more likely to develop autoimmune infiltrative orbitopathy, and the disease is clearly affected by several factors such as smoking, age, sex and race.
Retrospective and descriptive study of 150 patients, between the period of 2003 and 2006 in the Thyroid Clinic of the "Instituto de Oftalmología, Fundación Conde de Valenciana", Mexico City.
Our findings showed a higher incidence of dysthyroid strabismus in women 8:1, proptosis (72%), conjunctival chemosis (57%), eye lid retraction (43%), strabismus (24%), compressive neuropathy (14%), diplopia (9.5%) and miopathy demonstrated by orbit computerized tomography (50%). From the 150 patients the surgical management was, orbit decompression in the 10%, eye lid surgery in 8% and strabismus surgery in 5%.
By tomography findings we demonstrated the affectation of the extraocular muscles, observing that the inferior and medial rectus are affected the most, but non exempt, the lateral and superior rectus in smaller degree; having an important correlation with the disturbances of ocular motility predominating: limitation to the abduction in a 38%, adduction and elevation in a 35% and depression in 4%. Nevertheless the most common strabologic diagnosis is exotropia in a 13% without limitations associated to the ductions, hypertropia-hypotropia in an 8% and esotropia in a 3%, we attributed this variability to the chronicity of the pathology and secondary, to orbit decompression surgery. Strabismus is a common complication that results from the extraocular muscle infiltration, because of the natural history of the thyroid orbitopathy that ends in altered ocular movements attributed to the restrictive miopathy.
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