Skip to main content
SpringerLink
Log in

Strabismus in Thyroid Eye Disease

  • Chapter
  • First Online:
Thyroid Eye Disease

  • 1470 Accesses

Abstract

Strabismus in thyroid eye disease and the resulting diplopia represent one of the most functionally disabling aspects of the condition. It may occur from inflammation and subsequent fibrosis of the extraocular muscles (EOM), decompensation of underlying phorias due to orbital changes, or from mechanical factors after orbital decompression. The efficacy of early nonsurgical treatment in preventing strabismus from developing is being explored, but no standard regimen has proven, reliable efficacy. Because the EOM become abnormal, strabismus surgery is more challenging than in other types of adult-onset strabismus, and multiple operations are not uncommon. A number of methods for improving surgical results have been proposed, but an optimal strategy does not exist and results remain somewhat unpredictable.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Wiersinga WM, Smit T, van der Gaag R, Koornneef L. Temporal relationship between onset of Graves “ophthalmopathy and onset of thyroidal Graves” disease. J Endocrinol Invest. 1988;11(8):615–9.

    Article  CAS  PubMed  Google Scholar 

  2. Rapoport B, Alsabeh R, Aftergood D, McLachlan SM. Elephantiasic pretibial myxedema: insight into and a hypothesis regarding the pathogenesis of the extrathyroidal manifestations of Graves’ disease. Thyroid. 2000;10(8):685–92.

    Article  CAS  PubMed  Google Scholar 

  3. Kumar S, Iyer S, Bauer H, Coenen M, Bahn RS. A stimulatory thyrotropin receptor antibody enhances hyaluronic acid synthesis in graves’ orbital fibroblasts: inhibition by an IGF-I receptor blocking antibody. J Clin Endocrinol Metab. 2012;97(5):1681–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. van Zeijl CJJ, Fliers E, van Koppen CJ, Surovtseva OV, de Gooyer ME, Mourits MP, et al. Thyrotropin receptor-stimulating Graves “disease immunoglobulins induce hyaluronan synthesis by differentiated orbital fibroblasts from patients with Graves” ophthalmopathy not only via cyclic adenosine monophosphate signaling pathways. Thyroid. 2011;21(2):169–76.

    Article  PubMed  Google Scholar 

  5. Fells P, Kousoulides L, Pappa A, Munro P, Lawson J. Extraocular muscle problems in thyroid eye disease. Eye (Lond). 1994;8(Pt 5):497–505.

    Article  Google Scholar 

  6. Simonsz HJ, Kommerell G. Increased muscle tension and reduced elasticity of affected muscles in recent-onset Graves’ disease caused primarily by active muscle contraction. Doc Ophthalmol. 1989;72(3–4):215–24.

    Article  CAS  PubMed  Google Scholar 

  7. Pappa A, Jackson P, Stone J, Munro P, Fells P, Pennock C, et al. An ultrastructural and systemic analysis of glycosaminoglycans in thyroid-associated ophthalmopathy. Eye (Lond). 1998;12(Pt 2):237–44.

    Article  Google Scholar 

  8. Hansen C, Otto E, Kuhlemann K, Förster G, Kahaly GJ. Glycosaminoglycans in autoimmunity. Clin Exp Rheumatol. 1996;14 Suppl 15:S59–67.

    PubMed  Google Scholar 

  9. Fatourechi V. Pretibial myxedema: pathophysiology and treatment options. Am J Clin Dermatol. 2005;6(5):295–309.

    Article  PubMed  Google Scholar 

  10. Alsuhaibani AH, Carter KD, Policeni B, Nerad JA. Effect of orbital bony decompression for Graves’ orbitopathy on the volume of extraocular muscles. Br J Ophthalmol. 2011;95(9):1255–8.

    Article  PubMed  Google Scholar 

  11. Hu WD, Annunziata CC, Chokthaweesak W, Korn BS, Levi L, Granet DB, et al. Radiographic analysis of extraocular muscle volumetric changes in thyroid-related orbitopathy following orbital decompression. Ophthal Plast Reconstr Surg. 2010;26(1):1–6.

    Article  CAS  PubMed  Google Scholar 

  12. Baldeschi L, Lupetti A, Vu P, Wakelkamp IMMJ, Prummel MF, Wiersinga WM. Reactivation of Graves’ orbitopathy after rehabilitative orbital decompression. Ophthalmology. 2007;114(7):1395–402.

    Article  PubMed  Google Scholar 

  13. Müller-Forell W, Pitz S, Mann W, Kahaly GJ. Neuroradiological diagnosis in thyroid-associated orbitopathy. Exp Clin Endocrinol Diabetes. 1999;107 Suppl 5:S177–83.

    Article  PubMed  Google Scholar 

  14. Yokoyama N, Nagataki S, Uetani M, Ashizawa K, Eguchi K. Role of magnetic resonance imaging in the assessment of disease activity in thyroid-associated ophthalmopathy. Thyroid. 2002;12(3):223–7.

    Article  PubMed  Google Scholar 

  15. Terwee C, Wakelkamp I, Tan S, Dekker F, Prummel MF, Wiersinga W. Long-term effects of Graves’ ophthalmopathy on health-related quality of life. Eur J Endocrinol. 2002;146(6):751–7.

    Article  CAS  PubMed  Google Scholar 

  16. Bahn RS. Graves’ ophthalmopathy. N Engl J Med. 2010;362(8):726–38.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Skov CM, Mazow ML. Managing strabismus in endocrine eye disease. Can J Ophthalmol. 1984;19(6):269–74.

    CAS  PubMed  Google Scholar 

  18. Bartley GB, Fatourechi V, Kadrmas EF, Jacobsen SJ, Ilstrup DM, Garrity JA, et al. Clinical features of Graves’ ophthalmopathy in an incidence cohort. Am J Ophthalmol. 1996;121(3):284–90.

    Article  CAS  PubMed  Google Scholar 

  19. Bartley GB, Fatourechi V, Kadrmas EF, Jacobsen SJ, Ilstrup DM, Garrity JA, et al. Chronology of Graves’ ophthalmopathy in an incidence cohort. Am J Ophthalmol. 1996;121(4):426–34.

    Article  CAS  PubMed  Google Scholar 

  20. Flanders M, Hastings M. Diagnosis and surgical management of strabismus associated with thyroid-related orbitopathy. J Pediatr Ophthalmol Strabismus. 1997;34(6):333–40.

    CAS  PubMed  Google Scholar 

  21. Enzmann DR, Donaldson SS, Kriss JP. Appearance of Graves’ disease on orbital computed tomography. J Comput Assist Tomogr. 1979;3(6):815–9.

    Article  CAS  PubMed  Google Scholar 

  22. Holmes JM, Hatt SR, Bradley EA. Identifying masked superior oblique involvement in thyroid eye disease to avoid postoperative A-pattern exotropia and intorsion. J AAPOS. 2012;16(3):280–5.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Newman SA. Inferior oblique surgery for restrictive strabismus in patients with thyroid orbitopathy. Trans Am Ophthalmol Soc. 2009;107:72–90.

    PubMed Central  PubMed  Google Scholar 

  24. Dickinson AJ, Perros P. Controversies in the clinical evaluation of active thyroid-associated orbitopathy: use of a detailed protocol with comparative photographs for objective assessment. Clin Endocrinol (Oxf). 2001;55(3):283–303.

    Article  CAS  Google Scholar 

  25. Asman P. Ophthalmological evaluation in thyroid-associated ophthalmopathy. Acta Ophthalmol Scand. 2003;81(5):437–48.

    Article  PubMed  Google Scholar 

  26. Bartley GB. Rundle and his curve. Arch Ophthalmol. 2011;129(3):356–8.

    Article  PubMed  Google Scholar 

  27. Wiersinga WM, Bartalena L. Epidemiology and prevention of Graves’ ophthalmopathy. Thyroid. 2002;12(10):855–60.

    Article  PubMed  Google Scholar 

  28. Perros P, Crombie AL, Kendall-Taylor P. Natural history of thyroid associated ophthalmopathy. Clin Endocrinol (Oxf). 1995;42(1):45–50.

    Article  CAS  Google Scholar 

  29. Ben Simon GJ, Syed HM, Syed AM, Lee S, Wang DY, Schwarcz RM, et al. Strabismus after deep lateral wall orbital decompression in thyroid-related orbitopathy patients using automated hess screen. Ophthalmology. 2006;113(6):1050–5.

    Article  PubMed  Google Scholar 

  30. Roberts CJ, Murphy MF, Adams GG, Lund VJ. Strabismus following endoscopic orbital decompression for thyroid eye disease. Strabismus. 2003;11(3):163–71.

    Article  CAS  PubMed  Google Scholar 

  31. Fabian ID, Rosen N, Ben Simon GJ. Strabismus after inferior-medial wall orbital decompression in thyroid-related orbitopathy. Curr Eye Res. 2013;38(1):204–9.

    Article  PubMed  Google Scholar 

  32. Gilbert J, Dailey RA, Christensen LE. Characteristics and outcomes of strabismus surgery after orbital decompression for thyroid eye disease. J AAPOS. 2005;9(1):26–30.

    Article  PubMed  Google Scholar 

  33. Tellez M, Cooper J, Edmonds C. Graves’ ophthalmopathy in relation to cigarette smoking and ethnic origin. Clin Endocrinol (Oxf). 1992;36(3):291–4.

    Article  CAS  Google Scholar 

  34. Perros P, Crombie AL, Matthews JN, Kendall-Taylor P. Age and gender influence the severity of thyroid-associated ophthalmopathy: a study of 101 patients attending a combined thyroid-eye clinic. Clin Endocrinol (Oxf). 1993;38(4):367–72.

    Article  CAS  Google Scholar 

  35. Kendler DL, Lippa J, Rootman J. The initial clinical characteristics of Graves’ orbitopathy vary with age and sex. Arch Ophthalmol. 1993;111(2):197–201.

    Article  CAS  PubMed  Google Scholar 

  36. Metz HS, Woolf PD, Patton ML. Endocrine ophthalmomyopathy in adolescence. J Pediatr Ophthalmol Strabismus. 1982;19(1):58–60.

    CAS  PubMed  Google Scholar 

  37. Uretsky SH, Kennerdell JS, Gutai JP. Graves’ ophthalmopathy in childhood and adolescence. Arch Ophthalmol. 1980;98(11):1963–4.

    Article  CAS  PubMed  Google Scholar 

  38. Pfeilschifter J, Ziegler R. Smoking and endocrine ophthalmopathy: impact of smoking severity and current vs lifetime cigarette consumption. Clin Endocrinol (Oxf). 1996;45(4):477–81.

    Article  CAS  Google Scholar 

  39. Rajendram R, Bunce C, Adams GGW, Dayan CM, Rose GE. Smoking and strabismus surgery in patients with thyroid eye disease. Ophthalmology. 2011;118(12):2493–7.

    Article  PubMed  Google Scholar 

  40. Kahaly GJ, Pitz S, Hommel G, Dittmar M. Randomized, single blind trial of intravenous versus oral steroid monotherapy in Graves’ orbitopathy. J Clin Endocrinol Metab. 2005;90(9):5234–40.

    Article  CAS  PubMed  Google Scholar 

  41. Bartalena L, Krassas GE, Wiersinga W, Marcocci C, Salvi M, Daumerie C, et al. Efficacy and safety of three different cumulative doses of intravenous methylprednisolone for moderate to severe and active Graves’ orbitopathy. J Clin Endocrinol Metab. 2012;97(12):4454–63.

    Article  CAS  PubMed  Google Scholar 

  42. Macchia PE, Bagattini M, Lupoli G, Vitale M, Vitale G, Fenzi G. High-dose intravenous corticosteroid therapy for Graves’ ophthalmopathy. J Endocrinol Invest. 2001;24(3):152–8.

    Article  CAS  PubMed  Google Scholar 

  43. Gorman CA, Garrity JA, Fatourechi V, Bahn RS, Petersen IA, Stafford SL, et al. A prospective, randomized, double-blind, placebo-controlled study of orbital radiotherapy for Graves’ ophthalmopathy. Ophthalmology. 2001;108(9):1523–34.

    Article  CAS  PubMed  Google Scholar 

  44. Kazim M, Garrity JA. Orbital radiation therapy for thyroid eye disease. J Neuroophthalmol. 2012;32(2):172–6.

    Article  PubMed  Google Scholar 

  45. Salvi M, Vannucchi G, Currò N, Introna M, Rossi S, Bonara P, et al. Small dose of rituximab for graves orbitopathy: new insights into the mechanism of action. Arch Ophthalmol. 2012;130(1):122–4.

    Article  CAS  PubMed  Google Scholar 

  46. Khanna D, Chong KKL, Afifiyan NF, Hwang CJ, Lee DK, Garneau HC, et al. Rituximab treatment of patients with severe, corticosteroid-resistant thyroid-associated ophthalmopathy. Ophthalmology. 2010;117(1):133–9. e2.

    Article  PubMed Central  PubMed  Google Scholar 

  47. Weightman DR, Perros P, Sherif IH, Kendall-Taylor P. Autoantibodies to IGF-1 binding sites in thyroid associated ophthalmopathy. Autoimmunity. 1993;16(4):251–7.

    Article  CAS  PubMed  Google Scholar 

  48. Ezra DG, Krell J, Rose GE, Bailly M, Stebbing J, Castellano L. Transcriptome-level microarray expression profiling implicates IGF-1 and Wnt signalling dysregulation in the pathogenesis of thyroid-associated orbitopathy. J Clin Pathol. 2012;65(7):608–13.

    Article  CAS  PubMed  Google Scholar 

  49. Tamhankar MA, Ying G-S, Volpe NJ. Prisms are effective in resolving diplopia from incomitant, large, and combined strabismus. Eur J Ophthalmol. 2012;22:890–7.

    Article  PubMed  Google Scholar 

  50. De Pool ME, Campbell JP, Broome SO, Guyton DL. The dragged-fovea diplopia syndrome: clinical characteristics, diagnosis, and treatment. Ophthalmology. 2005;112(8):1455–62.

    Article  PubMed  Google Scholar 

  51. Dawson E, Ali N, Lee JP. Botulinum toxin injection into the superior rectus for treatment of strabismus. Strabismus. 2012;20(1):24–5.

    Article  CAS  PubMed  Google Scholar 

  52. Borumandi F, Hammer B, Kamer L, von Arx G. How predictable is exophthalmos reduction in Graves’ orbitopathy? A review of the literature. Br J Ophthalmol. 2011;95(12):1625–30.

    Article  PubMed  Google Scholar 

  53. Yoo SH, Pineles SL, Goldberg RA, Velez FG. Rectus muscle resection in Graves’ ophthalmopathy. J AAPOS. 2013;17(1):9–15.

    Article  PubMed Central  PubMed  Google Scholar 

  54. Prendiville P, Chopra M, Gauderman WJ, Feldon SE. The role of restricted motility in determining outcomes for vertical strabismus surgery in Graves’ ophthalmology. Ophthalmology. 2000;107(3):545–9.

    Article  CAS  PubMed  Google Scholar 

  55. Nguyen VT, Park DJJ, Levin L, Feldon SE. Correction of restricted extraocular muscle motility in surgical management of strabismus in graves’ ophthalmopathy. Ophthalmology. 2002;109(2):384–8.

    Article  PubMed  Google Scholar 

  56. Scott WE, Thalacker JA. Diagnosis and treatment of thyroid myopathy. Ophthalmology. 1981;88(6):493–8.

    Article  CAS  PubMed  Google Scholar 

  57. Evans D, Kennerdell JS. Extraocular muscle surgery for dysthyroid myopathy. Am J Ophthalmol. 1983;95(6):767–71.

    Article  CAS  PubMed  Google Scholar 

  58. Metz HS. Complications following surgery for thyroid ophthalmopathy. J Pediatr Ophthalmol Strabismus. 1984;21(6):220–2.

    CAS  PubMed  Google Scholar 

  59. Thomas SM, Cruz OA. Comparison of two different surgical techniques for the treatment of strabismus in dysthyroid ophthalmopathy. J AAPOS. 2007;11(3):258–61.

    Article  PubMed  Google Scholar 

  60. Coats DK, Paysse EA, Plager DA, Wallace DK. Early strabismus surgery for thyroid ophthalmopathy. Ophthalmology. 1999;106(2):324–9.

    Article  CAS  PubMed  Google Scholar 

  61. Peragallo JH, Velez FG, Demer JL, Pineles SL. Postoperative drift in patients with thyroid ophthalmopathy undergoing unilateral inferior rectus muscle recession. Strabismus. 2013;21(1):23–8.

    Article  PubMed Central  PubMed  Google Scholar 

  62. Dagi LR, Elliott AT, Roper-Hall G, Cruz OA. Thyroid eye disease: honing your skills to improve outcomes. J AAPOS. 2010;14:425–31.

    Article  PubMed  Google Scholar 

  63. Kushner BJ. Adjustable suture technique in strabismus surgery. Ophthalmol Clin North Am. 1992;5:93–103.

    Google Scholar 

  64. Trokel S, Moore S, Kazim M. Diplopia in Graves’ disease. Am Orthopt J. 1988;38:159–67.

    Google Scholar 

  65. Kraus DJ, Bullock JD. Treatment of thyroid ocular myopathy with adjustable and nonadjustable suture strabismus surgery. Trans Am Ophthalmol Soc. 1993;91:67–79. discussion 79–84.

    CAS  PubMed Central  PubMed  Google Scholar 

  66. Nicholson BP, De Alba M, Perry JD, Traboulsi EI. Efficacy of the intraoperative relaxed muscle positioning technique in thyroid eye disease and analysis of cases requiring reoperation. J AAPOS. 2011;15(4):321–5.

    Article  PubMed  Google Scholar 

  67. Dal Canto AJ, Crowe S, Perry JD, Traboulsi EI. Intraoperative relaxed muscle positioning technique for strabismus repair in thyroid eye disease. Ophthalmology. 2006;113(12):2324–30.

    Article  PubMed  Google Scholar 

  68. Haridas A, Sundaram V. Adjustable versus non-adjustable sutures for strabismus. Cochrane Database Syst Rev. 2013;7:CD004240.

    Google Scholar 

  69. Shen E, Porco T, Rutar T. Errors in strabismus surgery. JAMA Ophthalmol. 2013;131(1):75–9.

    Article  PubMed  Google Scholar 

  70. Mills MD, Coats DK, Donahue SP, Wheeler DT, American Academy of Ophthalmology. Strabismus surgery for adults: a report by the American Academy of Ophthalmology. Ophthalmology. 2004;111(6):1255–62.

    Article  PubMed  Google Scholar 

  71. Xu L, Glass LRD, Kazim M. Reactivation of thyroid eye disease following extraocular muscle surgery. Ophthal Plast Reconstr Surg. 2014;30:e5–6.

    Article  PubMed  Google Scholar 

  72. Gomi CF, Yang S-W, Granet DB, Kikkawa DO, Langham KA, Banuelos LR, et al. Change in proptosis following extraocular muscle surgery: effects of muscle recession in thyroid-associated orbitopathy. J AAPOS. 2007;11(4):377–80.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Neuro-Ophthalmology, Department of Ophthalmology, Wilmer Eye Institute, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Woods 457, Baltimore, MD, 21287, USA

    Bokkwan Jun M.D., Ph.D.

  2. Department of Ophthalmology, Neurology, and Neurosurgery, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Woods 457, Baltimore, MD, 21287, USA

    Prem S. Subramanian M.D., Ph.D.

Authors
  1. Bokkwan Jun M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Prem S. Subramanian M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Prem S. Subramanian M.D., Ph.D. .

Editor information

Editors and Affiliations

  1. Division of Eye Plastic, Orbital, and Facial Cosmetic Surgery, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA

    Raymond S. Douglas

  2. Division of Eye Plastic, Orbital, and Facial Cosmetic Surgery, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA

    Allison N. McCoy

  3. Division of Eye Plastic, Orbital, and Facial Cosmetic Surgery, Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA

    Shivani Gupta

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this chapter

Cite this chapter

Jun, B., Subramanian, P.S. (2015). Strabismus in Thyroid Eye Disease. In: Douglas, R., McCoy, A., Gupta, S. (eds) Thyroid Eye Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1746-4_10

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-1746-4_10

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1745-7

  • Online ISBN: 978-1-4939-1746-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation